Multifactorial risk index for predicting postoperative respiratory failure in men after major noncardiac surgery. The National Veterans Administration Surgical Quality Improvement Program.
OBJECTIVE
To develop and validate a preoperative risk index for predicting postoperative respiratory failure (PRF).


BACKGROUND
Respiratory failure is an important postoperative complication.


METHODS
Based on a prospective cohort study, cases from 44 Veterans Affairs Medical Centers (n = 81,719) were used to develop the models. Cases from 132 Veterans Affairs Medical Centers (n = 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.


RESULTS
PRF 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.


CONCLUSIONS
The 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.
Arozullah
A M
AM
Section of General Internal Medicine, University of Illinois College of Medicine, Chicago, Illinois 60612, USA. arozulla@uic.edu
Daley
J
J
Henderson
W G
WG
Khuri
S F
SF
D000368:Aged; D015331:Cohort Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology*; D012131:Respiratory Insufficiency / Q000453:epidemiology*; D012306:Risk; D012307:Risk Factors