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Three Risk Stratification Tools and Postoperative Pneumonia After Noncardiothoracic Surgery
Mariana L Laporta1, S Chandralekha Kruthiventi1, Carlos B Mantilla1
1Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.
The American Surgeon
|December 21, 2020
Summary
Preoperative risk assessment tools like ASA-PS, CCI, and Frailty Index predict postoperative pneumonia. Even patients with unknown frailty scores face increased pneumonia risk.
Area of Science:
- Medical research
- Clinical epidemiology
- Surgical outcomes
Background:
- Postoperative in-hospital pneumonia is a significant patient safety concern.
- Accurate preoperative risk stratification is crucial for patient management.
- Identifying reliable predictors can help mitigate pneumonia risk.
Purpose of the Study:
- To evaluate the association between three preoperative stratification tools and the risk of developing postoperative pneumonia.
- To compare the predictive capabilities of the American Society of Anesthesiologists Physical Status (ASA-PS) score, Charlson Comorbidity Index (CCI), and Rockwood Frailty Deficit Index (FI).
Main Methods:
- A matched case-control study design was employed.
- Adult patients who developed postoperative pneumonia after noncardiothoracic surgery under general anesthesia were identified.
- Patients were matched 1:1 with control subjects based on age, sex, and surgical procedure; medical records were reviewed for risk variables.
Main Results:
- All three stratification tools (ASA-PS, CCI, FI) were significantly associated with an increased risk of postoperative pneumonia.
- Higher ASA-PS scores, CCI values >3, and FI scores >3.25 correlated with greater pneumonia risk.
- Patients with "unknown frailty" (FI could not be calculated) also demonstrated a significantly elevated risk (odds ratio 3.15).
Conclusions:
- The ASA-PS score, CCI, and FI are valuable tools for stratifying patients at risk for postoperative pneumonia.
- The inability to calculate the Frailty Index due to incomplete data also indicates heightened patient vulnerability.
- These findings support the integration of these indices into preoperative assessments to identify high-risk individuals.
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