1. Development and validation of a score to predict postoperative respiratory failure in a multicentre European cohort: A prospective, observational study
- Author
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Sergi Sabaté, Luca Guzzetti, Maria Wittmann, Daniele Sances, Miriam De Nadal, Alexey Gritsan, Pablo Monedero, Paolo Pelosi, Daniela Filipescu, Cacho-Asenjo Elena, Cristina Ibanez-Esteve, RAQUEL FERNÁNDEZ-GARCÍA, Lluís Gallart, Enrique Carrero, and Mayte Ballester
- Subjects
Adult ,Male ,medicine.medical_specialty ,Critical Care ,MEDLINE ,Aparell respiratori -- Malalties ,Anesthesia, General ,Respiratory complication ,Cohort Studies ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Anesthesia, Conduction ,Risk Factors ,030202 anesthesiology ,medicine ,Humans ,Hospital Mortality ,Oximetry ,Prospective Studies ,030212 general & internal medicine ,Intensive care medicine ,Prospective cohort study ,Aged ,business.industry ,Middle Aged ,digestive system diseases ,3. Good health ,Europe ,Oxygen ,Treatment Outcome ,Anesthesiology and Pain Medicine ,Insuficiència respiratòria ,Respiratory failure ,Multicenter study ,Oxyhemoglobins ,Cohort ,Emergency medicine ,Female ,Observational study ,Respiratory Insufficiency ,business ,Cohort study - Abstract
BACKGROUND: Postoperative respiratory failure (PRF) is the most frequent respiratory complication following surgery. OBJECTIVE:/nThe 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 (SpO2) less than 90% whilst breathing room air that required conventional oxygen therapy, noninvasive or invasive mechanical ventilation./nRESULTS: 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 SpO2; 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). The PERISCOPE study was funded and supported through the European Society of Anaesthesiology’s Clinical Trials Network.
- Published
- 2015