title: Preoperative and intraoperative predictors of postoperative acute respiratory distress syndrome in a general surgical population.
abstract: BACKGROUND
  Acute respiratory distress syndrome (ARDS) is a devastating condition with an estimated mortality exceeding 30%. There are data suggesting risk factors for ARDS development in high-risk populations, but few data are available in lower incidence populations. Using risk-matched analysis and a combination of clinical and research data sets, we determined the incidence and risk factors for the development of ARDS in this general surgical population.
  
  
  METHODS
  We conducted a review of common adult surgical procedures completed between June 1, 2004 and May 31, 2009 using an anesthesia information system. This data set was merged with an ARDS registry and an institutional death registry. Preoperative variables were subjected to multivariate analysis. Matching and multivariate regression was used to determine intraoperative factors associated with ARDS development.
  
  
  RESULTS
  In total, 50,367 separate patient admissions were identified, and 93 (0.2%) of these patients developed ARDS. Preoperative risk factors for ARDS development included American Society of Anesthesiologist status 3-5 (odds ratio [OR] 18.96), emergent surgery (OR 9.34), renal failure (OR 2.19), chronic obstructive pulmonary disease (OR 2.16), number of anesthetics during the admission (OR 1.37), and male sex (OR 1.65). After matching, intraoperative risk factors included drive pressure (OR 1.17), fraction inspired oxygen (OR 1.02), crystalloid administration in liters (1.43), and erythrocyte transfusion (OR 5.36).
  
  
  CONCLUSIONS
  ARDS is a rare condition postoperatively in the general surgical population and is exceptionally uncommon in low American Society of Anesthesiologists status patients undergoing scheduled surgery. Analysis after matching suggests that ARDS development is associated with median drive pressure, fraction inspired oxygen, crystalloid volume, and transfusion.
authors.affiliation: Department of Anesthesiology, Michigan Center for Critical Illness and Injury Research, University of Michigan Health System, Ann Arbor, MI 48109, USA. jmblum@umich.edu
authors.forename: James M
authors.initials: JM
authors.lastname: Blum
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Stentz
authors.forename: Ronald
authors.initials: R
authors.lastname: Dechert
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Jewell
authors.forename: Milo
authors.initials: M
authors.lastname: Engoren
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Rosenberg
authors.forename: Pauline K
authors.initials: PK
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D016017:Odds Ratio; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D051437:Renal Insufficiency / Q000453:epidemiology; D012128:Respiratory Distress Syndrome / Q000175:diagnosis* / Q000453:epidemiology; D012307:Risk Factors; D017678:Sex Distribution; D013514:Surgical Procedures, Operative