Hall et al identified risk factors associated with pulmonary complications after laparotomy. This can help identify a patient who requires more aggressive management and closer monitoring. The authors are from Royal Perth Hospital in Australia.
Parameter identified on multivariate analysis:
(1) age
(2) ASA classification
(3) location of incision
(4) organs operated on
(5) preoperative hospital stay
(6) body mass index (BMI)
(7) residual intraperitoneal infection
|
Parameter |
Finding |
Points |
|
age |
<=59 years of age |
0 |
|
|
> 59 years of age |
1 |
|
ASA classification |
1 or 2 |
0 |
|
|
3, 4 or 5 |
1 |
|
location of incision |
upper abdominal |
1 |
|
|
other |
0 |
|
organs operated on |
colorectal or gastroduodenal |
1 |
|
|
other |
0 |
|
preoperative hospital stay |
<= 4 days |
0 |
|
|
> 4 days |
1 |
|
body mass index |
<= 25 |
0 |
|
|
> 25 |
1 |
|
residual intraperitoneal infection |
absent |
0 |
|
|
present |
1 |
where:
• BMI = (body weight in kilograms) / ((body height in meters)^2)
• Current smoking was a relatively insignificant factor for complications in the univariate and multivariate models.
• Upper abdominal incisions and residual intraperitoneal infection are associated with reduced respiratory tidal volume.
total number of risk factors =
= SUM(points for all 7 parameters)
Interpretation:
• minimum number of risk factors: 0
• maximum number of risk factors: 7
• The more risk factors that are present the greater the risk of a postoperative pulmonary complication.
An abbreviated risk score was based on age > 59 years and ASA classification > 1. The presence of these 2 findings identified 88% of patients who developed a postoperative pulmonary complication.
Specialty: Pulmonology, General Surgery
ICD-10: ,
