Description

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%

 


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