Development and validation of a score to predict postoperative respiratory failure in a multicentre European cohort:
Jaume Canet1, Sergi Sabaté, Valentín Mazo
1From the Department of Anaesthesiology and Postoperative Care Unit, Hospital Universitari Germans Trias i Pujol (JC, VM), Department of Anaesthesiology, Fundació, Puigvert (SS), Department of Anaesthesiology, Hospital del Mar, IMIM (Institut Hospital del Mar d' Investigacions Mèdiques), Universitat Autònoma de Barcelona, Barcelona, Spain (LG), Department of Anaesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany (MGDA), Department of Anaesthesia and Critical Care, Hospital Clínico Universitario, University of Valencia, Valencia, Spain (JB), Department of Anaesthesiology and Critical Care, Université, Pierre et Marie Curie-Paris VI, CHU Pitié-Salpêtrière, Paris, France (OL), Department of Anaesthesiology and Intensive Care Medicine, University of Bonn, Bonn, Germany (AH), and Department of Surgical Sciences and Integrated Diagnostics, IRCCS San Martino Hospital-IST, University of Genoa, Genoa, Italy (PP) *Members of the PERISCOPE (Prospective Evaluation of a RIsk Score for postoperative pulmonary COmPlications in Europe) group are listed in the Appendix.
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 (SpO2) 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 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).
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