title: Exploring National Surgical Quality Improvement Program respiratory comorbidities: developing a predictive understanding of postoperative respiratory occurrences, Clavien 4 complications, and death.
abstract: BACKGROUND
  For preoperative risk stratification, little is known about the implications of respiratory comorbidities in relation to postoperative complications in the diverse population of surgical patients. We hypothesized that patients with preoperative respiratory comorbidities would be at increased risk of postoperative respiratory occurrences and death.
  
  
  METHODS
  Under the data use agreement and with the approval of the Henry Ford Health System Institutional Review Board (IRB #6830), we reviewed 5 y (2005-2009) of National Surgical Quality Improvement Program participant use files. Respiratory comorbidities were defined as current smoker, chronic obstructive pulmonary disease, dyspnea, and current pneumonia. Respiratory outcomes tracked in the National Surgical Quality Improvement Program included reintubation, postoperative pneumonia, and prolonged ventilation. We defined Clavien 4 and 5 outcomes to include postoperative septic shock, postoperative dialysis, pulmonary embolism, myocardial infarction, cardiac arrest, prolonged ventilatory requirements, need for reintubation, and death.
  
  
  RESULTS
  Of 971,455 patients identified, 361,412 had respiratory comorbidities. As the number of respiratory comorbidities increased, we found a statistically significant increase in the occurrence of postoperative respiratory adverse events, including Clavien 4 and 5 complications. Multivariate regression analysis showed that respiratory comorbidities and age were independent predictors of mortality. All data reported here were significant at P < 0.001.
  
  
  CONCLUSIONS
  This study showed a significant association between respiratory comorbidities and postoperative adverse events, including Clavien 4 complications and death. Further prospective studies are required to explore this association.
authors: Department of Surgery, Henry Ford Hospital, Detroit, MI 48202, USA. ahodari1@hfhs.org
authors: Arielle
authors: A
authors: Hodari
authors: Athanasios
authors: A
authors: Tsiouris
authors: Michael
authors: M
authors: Eichenhorn
authors: Mathilda
authors: M
authors: Horst
authors: Ilan
authors: I
authors: Rubinfeld
mesh_terms: D015897:Comorbidity; D004417:Dyspnea / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007442:Intubation, Intratracheal; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology*; D011014:Pneumonia / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology*; D011184:Postoperative Period; D057234:Preoperative Period; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology*; D011655:Pulmonary Embolism / Q000453:epidemiology*; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012307:Risk Factors; D012772:Shock, Septic / Q000453:epidemiology*; D012907:Smoking / Q000453:epidemiology*; D016896:Treatment Outcome
keywords: Complications; Pneumonia; Postoperative; Ventilation