Structured abstract
Objective
How accurate is a 14-item index [postoperative pneumonia risk index (PPRI)] for estimating the 30-day risk of developing pneumonia in patients undergoing non-cardiac surgery?
Design
Two cohort studies — one for derivation and one for validation.
Setting
One hundred American Veterans Affairs medical centres that perform major surgery.
Patients
All non-cardiac operations performed under general, neuraxial, local, or monitored anesthesia at low-volume hospitals (< 140 cases per month) and the first 36 consecutive operations at high-volume hospitals (> 140 cases per month) were included. Operations with very low mortality rates, major transplantation procedures, and patients with postoperative respiratory failure or unplanned intubation prior to diagnosis of postoperative pneumonia were excluded. Data from 160,805 patients (80.3% of all eligible patients; 1 September 1997 to 31 August 1999) were used for index derivation and from 155,266 patients (82.1% of all eligible patients; 1 September 1995 to 31 August 1997) for validation. All patients were followed prospectively for 30 days after the initial operation. Less than 20% of patients were excluded due to missing data.
Description of prediction guide
Logistic regression was used to identify preoperative predictors of postoperative pneumonia. The PPRI is a 14-item index (maximum score 84 points) that divides patients into five classes of increasing risk (Table I) for postoperative pneumonia. Points are scored for type of surgery and anesthesia, general patient risk factors, respiratory risk factors, and neurological risk factors (Table II).
Main outcome measures
Postoperative pneumonia based on the Centers for Disease Control and Prevention definition.
Main results
Postoperative pneumonia developed in 1.5% of patients in the derivation cohort and 1.7% of patients in the validation cohort. The risk of postoperative pneumonia for patients in PPRI class 1,2, 3, 4, and 5 were similar between the two cohorts.
Conclusions
The PPRI classified patients into five levels of risk for postoperative pneumonia with good discrimination.
Funding
The Office of Patient Care Services and the Health Services Research and Development Service, Department of Veterans Affair.
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References
Lawrence VA, Hilsenbeck SG, Mulrow CD, Dhanda R, Sapp J, Pag CP. Incidence and hospital stay for cardiac and pulmonary complications after abdominal surgery. J Gen Intern Med 1995; 10: 671–8.
Arozullah AM, Daley J, Henderson WG, Khuri SF. Multifactorial risk index for predicting postoperative respiratory failure in men after major noncardiac surgery. The National Veterans Administration Surgical Quality Improvement Program. Ann Surg 2000; 232: 242–53.
Lijmer JG, Mol BW, Heisterkamp S, et al. Empirical evidence of design-related bias in studies of diagnostic tests. JAMA 1999; 282: 1061–6.
Fisher BW, Majumdar SR, McAlister FA. Predicting pulmonary complications after nonthoracic surgery: a systematic review of blinded studies. Am J Med 2002; 112: 219–25.
McAlister FA, Gajic O, Khan NA, Straus S, et al. The accuracy of the history, physical exam and routine tests in predicting postoperative pulmonary complications. Chest 2001; 120(Suppl 4): 289S.
References
Goldman L, Caldera DL, Nussbaum SR, et al. Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med 1977; 297: 845–50.
Arozullah AM, Daley J, Henderson WG, Khuri SF. Multifactorial risk index for predicting postoperative respiratory failure in men after major noncardiac surgery. The National Veterans Administration Surgical Quality Improvement Program. Ann Surg 2000; 232: 242–53.
Lee TH, Marcantonio ER, Mangione CM, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation 1999; 100: 1043–9.
Detsky AS, Abrams HB, McLaughlin JR, et al. Predicting cardiac complications in patients undergoing non-cardiac surgery. J Gen Intern Med 1986; 1: 211–9.
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Bradley, J., McAlister, F.A., McRae, K. et al. Best evidence in anesthetic practice. Can J Anesth 49, 655–658 (2002). https://doi.org/10.1007/BF03017440
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DOI: https://doi.org/10.1007/BF03017440