Development of a prediction rule for estimating postoperative pulmonary complications

PLoS One. 2014 Dec 1;9(12):e113656. doi: 10.1371/journal.pone.0113656. eCollection 2014.

Abstract

Patient- and procedure-related factors associated with postoperative pulmonary complications (PPCs) have changed over the last decade. Therefore, we sought to identify independent risk factors of PPCs and to develop a clinically applicable scoring system. We retrospectively analyzed clinical data from 2,059 patients who received preoperative evaluations from respiratory physicians between June 2011 and October 2012. A new scoring system for estimating PPCs was developed using beta coefficients of the final multiple regression models. Of the 2,059 patients studied, 140 (6.8%) had PPCs. A multiple logistic regression model revealed seven independent risk factors (with scores in parentheses): age ≥70 years (2 points), current smoker (1 point), the presence of airflow limitation (1 point), American Society of Anesthesiologists class ≥2 (1 point), serum albumin <4 g/dL (1 point), emergency surgery (2 points), and non-laparoscopic abdominal/cardiac/aortic aneurysm repair surgery (4 points). The area under the curve was 0.79 (95% CI, 0.75-0.83) with the newly developed model. The new risk stratification including laparoscopic surgery has a good discriminative ability for estimating PPCs in our study cohort. Further research is needed to validate this new prediction rule.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Cardiovascular Surgical Procedures / adverse effects*
  • Female
  • Humans
  • Laparoscopy / adverse effects*
  • Logistic Models
  • Lung Diseases / epidemiology*
  • Lung Diseases / etiology
  • Lung Diseases / prevention & control
  • Male
  • Middle Aged
  • Perioperative Care
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / etiology
  • Postoperative Complications / prevention & control
  • Retrospective Studies
  • Risk Factors

Grants and funding

This study was supported by Samsung Medical Center Foundation (SMO1140211). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.