Abstract
Patient- and procedure-related factors associated with postoperative pulmonary complications (PPCs) have changed over the last decade. Therefore, we sought to identify independent risk factors of PPCs and to develop a clinically applicable scoring system. We retrospectively analyzed clinical data from 2,059 patients who received preoperative evaluations from respiratory physicians between June 2011 and October 2012. A new scoring system for estimating PPCs was developed using beta coefficients of the final multiple regression models. Of the 2,059 patients studied, 140 (6.8%) had PPCs. A multiple logistic regression model revealed seven independent risk factors (with scores in parentheses): age ≥70 years (2 points), current smoker (1 point), the presence of airflow limitation (1 point), American Society of Anesthesiologists class ≥2 (1 point), serum albumin <4 g/dL (1 point), emergency surgery (2 points), and non-laparoscopic abdominal/cardiac/aortic aneurysm repair surgery (4 points). The area under the curve was 0.79 (95% CI, 0.75–0.83) with the newly developed model. The new risk stratification including laparoscopic surgery has a good discriminative ability for estimating PPCs in our study cohort. Further research is needed to validate this new prediction rule.
Highlights
Postoperative pulmonary complications (PPCs) are one of the most common perioperative adverse events in patients undergoing surgery and contribute to significant increases in morbidity, mortality, and length of postoperative hospital stay [1]
The following information was collected: data related to the patient (age, gender, body mass index (BMI), smoking status, alcohol habits, airflow limitation, comorbidities such as congestive heart failure (CHF), mental status, American Society of Anesthesiologists (ASA) physical status classification, serum albumin, serum hemoglobin, and chest radiograph findings) and the surgical operation, which are identified in the American College of Physicians (ACP) guidelines as PPC-related variables in patients undergoing non-cardiothoracic surgery
On the basis of this value, we developed a new scoring system to predict the occurrence of PPCs, composed of age >70 years (2 points), current smoker within 2 months (1 point), ASA class >2 (1 point), the presence of airflow limitation (1 point), serum albumin,4.0 g/dL (1 point), emergency surgery (2 points), and cardiac/aortic aneurysm repair/abdominal open surgery surgery (4 points), resulting in a maximum of 12 possible points
Summary
Postoperative pulmonary complications (PPCs) are one of the most common perioperative adverse events in patients undergoing surgery and contribute to significant increases in morbidity, mortality, and length of postoperative hospital stay [1]. Based on the American College of Physicians (ACP) guidelines for preventing PPCs in patients undergoing non-cardiothoracic surgery [5, 6], two main categories of risks are associated with the development of PPCs: patient-related and procedure-related risk factors. Despite these established factors, there are still various variables that should be evaluated perioperatively. Our goals were to identify independent risk factors of PPCs in the current clinical setting and to develop a clinically applicable scoring system
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