BACKGROUND Postoperative respiratory failure (PRF) is the most frequent respiratory complication following surgery. OBJECTIVE The objective of this study was to build a clinically useful predictive model for the development of PRF. DESIGN A prospective observational study of a multicentre cohort. SETTING Sixty-three hospitals across Europe. PATIENTS Patients undergoing any surgical procedure under general or regional anaesthesia during 7-day recruitment periods. MAIN OUTCOME MEASURES Development of PRF within 5 days of surgery. PRF was defined by a partial pressure of oxygen in arterial blood (PaO2) less than 8 kPa or new onset oxyhaemoglobin saturation measured by pulse oximetry (SpO(2)) less than 90% whilst breathing room air that required conventional oxygen therapy, noninvasive or invasive mechanical ventilation. RESULTS PRF developed in 224 patients (4.2% of the 5384 patients studied). In-hospital mortality [95% confidence interval (95% CI)] was higher in patients who developed PRF [10.3% (6.3 to 14.3) vs. 0.4% (0.2 to 0.6)]. Regression modelling identified a predictive PRF score that includes seven independent risk factors: low preoperative SpO(2); at least one preoperative respiratory symptom; preoperative chronic liver disease; history of congestive heart failure; open intrathoracic or upper abdominal surgery; surgical procedure lasting at least 2 h; and emergency surgery. The area under the receiver operating characteristic curve (c-statistic) was 0.82 (95% CI 0.79 to 0.85) and the Hosmer-Lemeshow goodness-of-fit statistic was 7.08 (P = 0.253). CONCLUSION A risk score based on seven objective, easily assessed factors was able to predict which patients would develop PRF. The score could potentially facilitate preoperative risk assessment and management and provide a basis for testing interventions to improve outcomes. The study was registered at ClinicalTrials.gov (identifier NCT01346709).
Development and validation of a score to predict postoperative respiratory failure in a multicentre European cohort : A prospective, observational study / J. Canet, S. Sabate, V. Mazo, L. Gallart, M.G. de Abreu, J. Belda, O. Langeron, A. Hoeft, P. Pelosi, O. Langeron, J. Burimi, A. Hoeft, B. Leva, J. Burimi, T. Halefi, A. Hoxha, K. Pilika, I. Selmani, V. Daout, C. Gauthier, D. Kahn, M. Momeni, C. Watremez, S. Straus, D. Djonovic-Manovic, M. Juros-Zovko, H. Komen-Usljebrka, V. Orlic, I. Stuck, L. Balakova, M. Kosinova, I. Krikava, R. Stoudek, P. Stourac, K. Zadrazilova, S. Janvekar, J. Karjagin, K. Roivassepp, A. Sormus, P. Cuvillon, C. Ibanez-Esteve, O. Langeron, M. Raux, A. Nicolas-Robin, A. Winter, M. Brunier, K. Engelhard, R.L. Feldmann, R. Lindemann, S. Mauff, A. Sebastiani, C. Zamperoni, A. Hoeft, F. Kessler, M. Wittmann, T. Bluth, M.G. de Abreu, A. Guldner, T. Kiss, K. Braz, C. Ruszkai, M. Micaglio, C. Ori, M. Parotto, P. Persona, C. Giuseppe, P. Carnesecchi, D. Lazzeroni, I. Lorenzi, G. Castellani, D. Sances, G. Spano, S. Tredici, D. Vezzoli, I. Brunetti, A. Di Noto, A. Gratarola, A. Molin, L. Montagnani, G. Pellerano, P. Pelosi, M. Fusari, L. Camici, L. Guzzetti, F. Marangoni, P. Severgnini, P. Di Mauro, F. Rapido, C. Tommasino, I. Nemme, J. Nemme, J. Blieka, J. Borodiciene, B. Budryte, A. Karbonskiene, I. Kiudulaite, E. Milieskaite, R. Rasimaviciute, U. Sireviciene, R. Stasaityte, E. Usas, G. Zarskiene, E. Kontrimaviciute, J. Sipylaite, G. Tomkute, P. Bardea, M. Klop, M. Koch, D. Bozilow, R. Goch, J. Bonifacio, S. Marques, T. Teresa dos Santos Ralha, D. Alves, I. Carvalho, J.S. Da Cruz Parente, S. Tome, C. Carmona, M. Costa, M. Lina, S. Sierra, A. Balcan, I. Cindea, V.I. Gherghina, C. Grasa, R. Copotoiu, S. Copotoiu, J. Kovacs, J. Szederjesi, A. Theil, D. Filipescu, A. Grytsan, T. Kapkan, S. Rostovtsev, A. Yushkova, R. Calderon, E. Cacho, C. Marginet, P. Monedero, M. Jose Yepes, J.M. Esparza Minana, M. Granell Gil, G. Rico Portoles, A. Lisi, G. Perez, N. Poch, M.R. Arganaraz Quinteros, C. Font Bosch, J. Torrellardona Llobera, S. Sabate, P. Sierra, M. Matute, A. Alcon Dominguez, M. Jose Arguis, I. Belda, E. Carrero, J. Moreno, I. Rovira, M. Ubre, R. Castillo, S. Herrero, M.T. Ballester Lujan, F.J. Belda, J. Carbonell, G. Gencheva, A. Gutierrez, J. Llorens, S. Machado, F. Llobell, D. Paz Martin, F. Javier Garcia-Miguel, A. Perez Garcia, R. Company, A. Ahamdanech Idrissi, J. del Fresno Canaveras, J.A. Navarro Martinez, E. Paya Martinez, E. Sanchez Garcia, J. Vera Bella, I. India Aldana, J. Manuel Campos, X. Pelaez Vaamonde, M. Torra, R. Arroyo, J. Carlos Cabrera, J. Carazo Cordobes, L. Gallart, A. Rojo, F. Javier Santiveri, J. Canet, M. Gonzalez, A. Jimenez, Y. Jimenez, A. Marti, V. Mazo, E. Moret, M. Rodriguez Nunez, J. Velasco, A. Calderon, M. Gonzalez, O. Gonzalez, A. Hermira Anchuelo, E. Lopez, E. Sanchez, B. Aznarez Zango, F.J. Garcia Corral, E. Mata Mena, A. Planas Roca, R.F.R. Ayala Soto, B. Quintana, J.M. Rabanal Llevot, M.M. Williams Camus, A. Palacios Blanco, A. Largo Ruiz, J. Rico Feijoo, E. Castellano Garijo, J. Belmonte Cuenca, M.J. Bonet Binimelis, I. Grigorov, J. Lluis Aguilar, M. De Nadal Clanchet, E. Guerrero Vinas, S. Manrique Muniz, V. Martin Mora, F. Munar Bauza, S. Nunez Aguado, M. Olive Vidal, M.L. Panos Gozalo, M. Sanchez Marin, M.C. Suescun Lopez, P. Maino, Y.E. Yevstratov, S. Kucukgoncu, N.M. Senturk, Z.S. Ulke. - In: EUROPEAN JOURNAL OF ANAESTHESIOLOGY. - ISSN 0265-0215. - 32:7(2015), pp. 458-470. [10.1097/EJA.0000000000000223]
Development and validation of a score to predict postoperative respiratory failure in a multicentre European cohort : A prospective, observational study
C. Tommasino;
2015
Abstract
BACKGROUND Postoperative respiratory failure (PRF) is the most frequent respiratory complication following surgery. OBJECTIVE The objective of this study was to build a clinically useful predictive model for the development of PRF. DESIGN A prospective observational study of a multicentre cohort. SETTING Sixty-three hospitals across Europe. PATIENTS Patients undergoing any surgical procedure under general or regional anaesthesia during 7-day recruitment periods. MAIN OUTCOME MEASURES Development of PRF within 5 days of surgery. PRF was defined by a partial pressure of oxygen in arterial blood (PaO2) less than 8 kPa or new onset oxyhaemoglobin saturation measured by pulse oximetry (SpO(2)) less than 90% whilst breathing room air that required conventional oxygen therapy, noninvasive or invasive mechanical ventilation. RESULTS PRF developed in 224 patients (4.2% of the 5384 patients studied). In-hospital mortality [95% confidence interval (95% CI)] was higher in patients who developed PRF [10.3% (6.3 to 14.3) vs. 0.4% (0.2 to 0.6)]. Regression modelling identified a predictive PRF score that includes seven independent risk factors: low preoperative SpO(2); at least one preoperative respiratory symptom; preoperative chronic liver disease; history of congestive heart failure; open intrathoracic or upper abdominal surgery; surgical procedure lasting at least 2 h; and emergency surgery. The area under the receiver operating characteristic curve (c-statistic) was 0.82 (95% CI 0.79 to 0.85) and the Hosmer-Lemeshow goodness-of-fit statistic was 7.08 (P = 0.253). CONCLUSION A risk score based on seven objective, easily assessed factors was able to predict which patients would develop PRF. The score could potentially facilitate preoperative risk assessment and management and provide a basis for testing interventions to improve outcomes. The study was registered at ClinicalTrials.gov (identifier NCT01346709).
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