Jeong et al developed a predictive model for postoperative pulmonary complications for adults. This can help to identify a patient who may benefit from more aggressive management. The authors are from Sungkyunkwan University, Pusan National University and Samsung Biomedical Research Institute.
Patient selection: age >= 18 years; non-pulmonary surgery
Exclusions: pregnancy-related, obstetrical, organ transplant
Outcome: postoperative pulmonary complications within the first 7 days after surgery (respiratory infection, respiratory failure, pleural effusion, atelectasis, pneumothorax, bronchospasm)
Parameters
(1) age of the patient in years
(2) current smoker within the past 2 months
(3) airflow limitation (FEV1 < 80% of predicted; FEV1/FVC < 0.7)
(4) ASA class
(5) serum albumin in g/dL
(6) emergency surgery
(7) non-laparoscopic surgery (abdominal, cardiac, aortic aneurysm)
|
Parameter
|
Finding
|
Points
|
|
age of the patient
|
< 70 years
|
0
|
|
|
>= 70 years
|
2
|
|
current smoker
|
no
|
0
|
|
|
yes
|
1
|
|
airflow limitation
|
no
|
0
|
|
|
yes
|
1
|
|
ASA class
|
1
|
0
|
|
|
2 or higher
|
1
|
|
serum albumin
|
>= 4.0 g/dL
|
0
|
|
|
< 4.0 g/dL
|
1
|
|
emergency surgery
|
no
|
0
|
|
|
yes
|
2
|
|
nonlaparoscopic surgery
|
no
|
0
|
|
|
yes
|
4
|
total score =
= SUM(points for all 7 parameters)
Interpretation:
• minimum score: 0
• maximum score: 12
• The higher the score the greater the risk of postoperative pulmonary complications.
|
Total Score
|
Risk
|
Rate
|
|
0 to 3
|
low
|
1.8%
|
|
4 to 6
|
intermediate
|
9.5%
|
|
7 to 9
|
high
|
24%
|
|
10 to 12
|
very high
|
43%
|
Performance:
• The area under the ROC curve was 0.79.
