Arozullah et al developed a risk index for predicting the risk of respiratory failure in men after major noncardiac surgery. This can help identify patients preoperatively who may require more aggressive management and closer monitoring. The authors are from the University of Illinois, Harvard University, the National Veterans Administration Surgical Quality Improvement Program and several other hospitals.
NOTE: Arozullah also developed a risk index for predicting postoperative pneumonia.
Patient selection: males in a Veterans Administration Medical Center undergoing major noncardiac surgery
Parameters:
(1) type of surgery
(2) urgency of surgery
(3) serum albumin
(4) BUN
(5) functional status
(6) history of chronic obstructive pulmonary disease (COPD)
(7) age in years
Parameter |
Finding |
Points |
---|---|---|
type of surgery |
abdominal aortic aneurysm |
27 |
|
thoracic surgery |
21 |
|
neurosurgery |
14 |
|
upper abdominal |
14 |
|
peripheral vascular disease |
14 |
|
neck |
11 |
|
other |
0 |
surgical urgency |
emergency surgery |
11 |
|
non-emergency |
0 |
serum albumin |
>= 3.0 g/dL |
0 |
|
< 3.0 g/dL |
9 |
BUN |
<= 30 mg/dL |
0 |
|
> 30 mg/dL |
8 |
functional status |
independent |
0 |
|
partially dependent |
7 |
|
fully dependent |
7 |
history of COPD |
none |
0 |
|
present |
6 |
age of the patient in years |
< 60 years of age |
0 |
|
60 - 69 years of age |
4 |
|
>= 70 years of age |
6 |
where:
• Partially dependent indicates requires use of equipment and/or assistance from another person for some activities of daily living. This would include a person in a nursing home who is not fully dependent, a person receiving dialysis or a person on home ventilatory support (see page 243).
total score =
= SUM(points for all 7 parameters)
Interpretation:
• minimum score: 0
• maximum score: 74 (if count only 1 type of surgery)
• The higher the score the greater the risk of post-operative respiratory failure.
Total Score |
Group |
Probability of Post-operative Respiratory Failure |
---|---|---|
<= 10 |
1 |
0.5% |
11 - 19 |
2 |
2.2% |
20 - 27 |
3 |
5.0% |
28 - 40 |
4 |
11.6% |
> 40 |
5 |
30.5% |
Purpose: To evaluate a male undergoing major noncardiac surgery for risk of postoperative respiratory failure using the risk index of Arozullah et al.
Specialty: Pulmonology, Surgery, general
Objective: risk factors, severity, prognosis, stage, complications
ICD-10: J96, J95.2,