title: Clinical application of the Melbourne risk prediction tool in a high-risk upper abdominal surgical population: an observational cohort study.
abstract: OBJECTIVE
  (1) To determine the ability of the Melbourne risk prediction tool to predict a pulmonary complication as defined by the Melbourne Group Scale in a medically defined high-risk upper abdominal surgery population during the postoperative period; (2) to identify the incidence of postoperative pulmonary complications; and (3) to examine the risk factors for postoperative pulmonary complications in this high-risk population.
  
  
  METHODS
  Observational cohort study.
  
  
  METHODS
  Tertiary Australian referral centre.
  
  
  METHODS
  50 individuals who underwent medically defined high-risk upper abdominal surgery. Presence of postoperative pulmonary complications was screened daily for seven days using the Melbourne Group Scale (Version 2). Postoperative pulmonary risk prediction was calculated according to the Melbourne risk prediction tool.
  
  
  METHODS
  (1) Melbourne risk prediction tool; and (2) the incidence of postoperative pulmonary complications.
  
  
  RESULTS
  Sixty-six percent (33/50) underwent hepatobiliary or upper gastrointestinal surgery. Mean (SD) anaesthetic duration was 377.8 (165.5) minutes. The risk prediction tool classified 84% (42/50) as high risk. Overall postoperative pulmonary complication incidence was 42% (21/50). The tool was 91% sensitive and 21% specific with a 50% chance of correct classification.
  
  
  CONCLUSIONS
  This is the first study to externally validate the Melbourne risk prediction tool in an independent medically defined high-risk population. There was a higher incidence of pulmonary complications postoperatively observed compared to that previously reported. Results demonstrated poor validity of the tool in a population already defined medically as high risk and when applied postoperatively. This observational study has identified several important points to consider in future trials.
authors: Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Alan Gilbert Building, Level 7, 161 Barry Street, Carlton 3053, VIC, Australia; Department of Physiotherapy, Austin Health, Heidelberg 3084, VIC, Australia. Electronic address: selina.parry@austin.org.au.
authors: S
authors: S
authors: Parry
authors: Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Alan Gilbert Building, Level 7, 161 Barry Street, Carlton 3053, VIC, Australia.
authors: L
authors: L
authors: Denehy
authors: Department of Physiotherapy, Austin Health, Heidelberg 3084, VIC, Australia.
authors: S
authors: S
authors: Berney
authors: Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Alan Gilbert Building, Level 7, 161 Barry Street, Carlton 3053, VIC, Australia.
authors: L
authors: L
authors: Browning
mesh_terms: D000368:Aged; D001315:Australia; D015897:Comorbidity; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D005260:Female; D015438:Health Behavior; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012140:Respiratory Tract Diseases / Q000209:etiology*; D018570:Risk Assessment; D012307:Risk Factors; D062606:Tertiary Care Centers
keywords: Abdominal surgery; Physiotherapy; Postoperative care; Pulmonary complications; Risk prediction