Variable definitions: implications for the prediction of pulmonary complications after adult cardiac surgery.
OBJECTIVE
The aim of this paper was to review the implications that variable definitions have for the prediction of post-operative pulmonary complications after cardiac surgery.


METHODS
A review of the literature from 1980 to 2002. Selected studies demonstrated an original attempt to examine multivariate associations between pre, intra or post-operative antecedents and pulmonary outcomes in patients undergoing coronary artery bypass grafting (CABG). Reports that described the validation of established clinical prediction rules, testing interventions or research conducted in non-human cohorts were excluded from this review.


RESULTS
Consistently, variable factor and outcome definitions are combined for the development of multivariate prediction models that subsequently have limited clinical value. Despite being prevalent there are very few attempts to examine post-operative pulmonary complications (PPC) as endpoints in isolation. The trajectory of pulmonary dysfunction that precedes complications in the post-operative context is not clear. As such there is little knowledge of post-operative antecedents to PPC that are invariably excluded from model development.


CONCLUSIONS
Multivariate clinical prediction rules that incorporate antecedent patient and process factors from the continuum of cardiovascular care for specific pulmonary outcomes are recommended. Models such as these would be useful for practice, policy and quality improvement.
Wynne
Rochelle
R
The Alfred/Deakin Nursing Research Centre, School of Nursing, Faculty of Health and Behavioural Sciences, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125 Australia. rwynne@deakin.edu.au
D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003661:Decision Support Techniques; D006801:Humans; D015994:Incidence; D008171:Lung Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D015233:Models, Statistical; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods* / Q000592:standards; D012307:Risk Factors; D016896:Treatment Outcome