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A novel nephrectomy-specific respiratory failure index using the ACS-NSQIP dataset

  • Urology - Original Paper
  • Published:
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Abstract

Purpose

Post-operative pulmonary failure is a major complication of nephrectomy that may lead to severe morbidity and mortality. Hence, we aimed to derive a nephrectomy-specific post-operative respiratory failure index.

Methods

Our cohort was derived from The American College of Surgeons—National Surgical Quality Improvement Program database between 2005 and 2019. The outcome of interest was post-operative respiratory failure (PRF) defined as any incidence of unplanned intubation post-operatively or requiring mechanical ventilation post-operatively for a period > 48 h. A multivariable logistic regression model was constructed, and model calibration and performance were assessed using a ROC analysis and the Hosmer–Lemeshow test. Finally, we derived the nephrectomy-specific respiratory failure (NSRF) index and compared it to Gupta’s index.

Results

Seventy-nine thousand five hundred and twenty-three patients underwent nephrectomy between the years 2005 and 2019 of which nine hundred and sixty-two patients developed PRF. The final NSRF model encompassed ten variables: age, smoking status, American society of anesthesiology class, abnormal creatinine (≥ 1.5 mg/dL), anemia (< 36%), functional health status, chronic obstructive pulmonary disease, surgical approach, emergency case, and obesity (≥ 40 kg/m2). The NSRF ROC analysis provided C-statistic = 0.78, calibration R2 = 0.99, and proper goodness of fit. In comparison, the C-statistics of Gupta’s index was found to be 0.71 (p value < 0.001).

Conclusion

The NSRF is a procedure tailored index for predicting post-operative respiratory failure. It is a valuable tool in the pre-operative evaluation setting that can help identify high-risk patients who will require additional respiratory evaluation and preparation for their surgery.

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Data availability

The (ACS-NSQIP) data are subject to a data use agreement. To access the dataset, a request to the ACS-NSQIP participant-use form should be placed at the following link (https://www.facs.org/quality-programs/acs-nsqip/participant-use). The American University of Beirut Medical Center is enrolled in ACS-NSQIP as a participating center. As such, the data were made available by the ACS-NSQIP center and the AUBMC Department of Surgery after signing the data use agreement.

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Funding

No funding was received to assist with the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Surgery, Division of Urology, American University of Beirut Medical Center, Riad El Solh, PO BOX: 11-0236, Beirut, 1107 2020, Lebanon

    Christian H. Ayoub, Jose M. El-Asmar, Adnan El-Achkar, Elia Abou Chawareb & Albert El Hajj

  2. Medical School, American University of Beirut, American University of Beirut, Beirut, Lebanon

    Ali Dakroub & Layane El-Khoury

  3. Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon

    Hani Tamim

  4. College of Medicine, Alfaisal University, Riyadh, Saudi Arabia

    Hani Tamim

  5. Department of Anesthesia and Intensive Care, Saint-Joseph University Medical School, Hotel-Dieu de France Hospital, Beirut, Lebanon

    Viviane Chalhoub

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  1. Christian H. Ayoub
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Contributions

CHA: conceptualized the study, retrieved, and analyzed the data, and wrote/edited the manuscript. JMA: conceptualized the study, wrote/edited the manuscript. AEA wrote/edited the manuscript. ADE, AC/L, ElK: wrote/edited the manuscript. HT: helped in retrieval and analyzed the data. A.EHVC: project conception/design, manuscript writing/editing. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Viviane Chalhoub or Albert El Hajj.

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Conflict of interest

The authors have no competing interests to declare that are relevant to the content of this article.

Ethical approval and consent to participate

The de-identified database (ACS-NSQIP) does not constitute human subject research; therefore, no consent to participate or institutional review board (IRB) approval was required or attained.

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Ayoub, C.H., El-Asmar, J.M., El-Achkar, A. et al. A novel nephrectomy-specific respiratory failure index using the ACS-NSQIP dataset. Int Urol Nephrol 55, 813–822 (2023). https://doi.org/10.1007/s11255-023-03507-2

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