Multifactorial Risk Index for Predicting Postoperative Respiratory Failure in Men After Major Noncardiac Surgery

Abstract

ObjectiveTo develop and validate a preoperative risk index for predicting postoperative respiratory failure (PRF). Summary Background DataRespiratory failure is an important postoperative complication. MethodBased on a prospective cohort study, cases from 44 Veterans Affairs Medical Centers (n ϭ 81,719) were used to develop the models. Cases from 132 Veterans Affairs Medical Centers (n ϭ 99,390) were used as a validation sample. PRF was defined as mechanical ventilation for more than 48 hours after surgery or reintubation and mechanical ventilation after postoperative extubation. Ventilator-dependent, comatose, do not resuscitate, and female patients were excluded. ResultsPRF developed in 2,746 patients (3.4%). The respiratory failure risk index was developed from a simplified logistic regression model and included abdominal aortic aneurysm repair, thoracic surgery, neurosurgery, upper abdominal surgery, peripheral vascular surgery, neck surgery, emergency surgery, albumin level less than 30 g/L, blood urea nitrogen level more than 30 mg/dL, dependent functional status, chronic obstructive pulmonary disease, and age. ConclusionsThe respiratory failure risk index is a validated model for identifying patients at risk for developing PRF and may be useful for guiding perioperative respiratory care.Postoperative pulmonary complications greatly contribute to the death and complication rates of surgery. It has been reported that 5% to 10% of all surgical patients and 9% to 40% of those undergoing abdominal surgery experience postoperative pulmonary complications.

Implications of extubation failure and prolonged mechanical ventilation in the postoperative period following elective intracranial surgery

“…Other studies have reported that extubation failure increases the risk of pulmonary complications, mortality, duration of MV, and an increased length of ICU stay (5,6,17). The need for reintubation is a risk factor for the development of pulmonary infection (5,18,19) because it favors bronchoaspiration and alterations in mucociliary clearance, which may lead to bacterial contamination and colonization of the airways (14,20).…”

“…The time interval for defining prolonged MV or extubation failure has yet to be established, ranging from 6 to 48 h in recent studies (6)(7)(8)(9) and from 2 to 7 days in older studies (10,11). The maintenance of patients on MV for a prolonged length of time can cause complications such as development of oxygen toxicity, larynx injuries, tracheal stenosis, selective intubation, sinusitis, barotrauma, reduced cardiac output, pneumonia, and psychological problems (12).…”

Review article: Age related alterations in respiratory function — anesthetic considerations

“…42,48,49 For example, in a recent study 48 significant multivariate predictors of pulmonary complications after non-thoracic surgery were age > 65 yr, and a smoking history of more than 40 yr. Pedersen et al 50 found that risk factors for perioperative pulmonary complications included patient age older than 70 yr, chronic obstructive lung disease, major surgery, and the use of muscle relaxants during anesthesia. A recent literature review confirmed that advanced age is a risk factor for postoperative pulmonary complications, even after adjustment for other comorbid conditions.…”

Cirurgia ortopédica em idosos: aspectos clínicos

“…Occurrences of these complications are closely linked to the existence of risk factors relating to the patient and to the procedure. The main factors encountered were ASA > 2, chest X-ray showing abnormalities, age > 70 years, congestive heart failure, albumin < 3.5 mg/dl, aortic surgery, chest surgery, upper abdominal surgery and prolonged surgery (19)(20)(21) .…”

“…All patients should undergo respiratory and motor physiotherapy starting from when they are admitted to hospital, with the aim of preventing respiratory complications, which increase mortality and prolong hospitalization (8,20,21) (Table 6). …”