Cardiopulmonary risk index does not predict complications after thoracic surgery.
OBJECTIVE
The preoperative cardiopulmonary risk index (CPRI) is a multifactorial index intended to predict postoperative outcome after thoracic surgery. It combines cardiac and pulmonary information into one parameter that ranges from 1 to 10, with 10 being the worst. A CPRI > or = 4 has been advocated as an effective predictor of postoperative pulmonary and cardiac complications. This study prospectively evaluates the predictive value of CPRI in a large population of patients undergoing thoracic surgery.


METHODS
We performed prospective calculation of CPRI in patients about to undergo thoracic surgery. Postthoracic surgery occurrence of pneumonia, atelectasis, arrhythmias, congestive heart failure, respiratory failure requiring therapy, or death occurring within 30 days of surgery was compared with preoperative CPRI and its components.


METHODS
One hundred eighty consecutive patients, aged 15 to 87 years, were studied.


METHODS
Operations performed included 114 lobectomies, 35 wedge resections, 19 pneumonectomies, 5 pleurectomies, 5 lymph node dissections, 1 thoracic wall resection, and 1 paravertebral tumor resection.


RESULTS
Twenty-seven percent of patients experienced complications. CPRI and its components did not predict complications, deaths, or the number of in-hospital days. We found a CPRI > or = 4 to be a moderate predictor of outcome for patients undergoing pneumonectomy (n = 19). It correctly identified four of nine postpneumonectomy complications.


CONCLUSIONS
The preoperative CPRI and its components are inadequate predictors of medical complications after thoracic surgery in a general population. In the subgroup of patients undergoing pneumonectomy, the index may be of some value in forecasting outcome.
Department of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
J A
JA
Melendez
V A
VA
Carlon
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000209:etiology; D002423:Cause of Death; D005069:Evaluation Studies as Topic; D005260:Female; D005544:Forecasting; D006331:Heart Diseases / Q000209:etiology*; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D007902:Length of Stay; D008171:Lung Diseases / Q000209:etiology*; D008197:Lymph Node Excision / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010994:Pleura / Q000601:surgery; D011013:Pneumonectomy / Q000009:adverse effects; D011014:Pneumonia / Q000209:etiology; D011446:Prospective Studies; D001261:Pulmonary Atelectasis / Q000209:etiology; D012131:Respiratory Insufficiency / Q000209:etiology; D012307:Risk Factors; D013125:Spinal Neoplasms / Q000601:surgery; D019616:Thoracic Surgical Procedures / Q000009:adverse effects*; D016896:Treatment Outcome