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Postoperative pulmonary complications prolong hospital stays and can be associated with perioperative mortality. In a prospective study from Spain, designed to identify predictors of pulmonary complications, researchers closely followed 2500 randomly selected patients who underwent inpatient surgery at 59 hospitals. Pulmonary complications were defined broadly and included infection, aspiration, bronchospasm, respiratory failure, pleural effusion, and atelectasis.
Seven variables independently predicted pulmonary complications: older age, low preoperative oxygen (O2) saturation, respiratory infection during the previous month, preoperative hemoglobin level <10 g/dL, upper abdominal or thoracic procedure, duration of surgery >2 hours, and emergency procedure. Each variable was assigned a specified number of points, points were summed to yield a risk score, and cutoffs established low-, intermediate-, and high-risk groups. In these three groups, risks for at least one pulmonary complication were ≈1%, ≈10%, and ≈40%, respectively. Thirty-day mortality in patients with 0, 1, and ≥2 pulmonary complications was 0.5%, 9%, and 32%.
Canet J et al. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology 2010 Dec; 113:1338. (http://dx.doi.org/10.1097/ALN.0b013e3181fc6e0a)
Comment
Readers might be surprised that certain variables (e.g., smoking or previously diagnosed pulmonary disease) were not in the final prediction model; presumably, inclusion of O2 saturation caused these other variables to “drop out” as independent predictors. The next steps are to validate this model elsewhere and to see whether its use can lead to interventions that lower perioperative risk.