Arozullah et al developed a multifactorial risk index associated with the risk of developing a postoperative pneumonia in a patient following major noncardiac surgery. The index uses data available prior to surgery, so that patients at high risk can be identified previous to onset of the pneumonia. The authors are from the National Veteran Affairs Surgical Quality Improvement Program.
Criteria for postoperative pneumonia: CDC definition of nosocomial pneumonia
Exclusion criteria (page 848):
(1) ventilation dependent prior to surgery
(2) preoperative pneumonia
(3) postoperative respiratory failure
(4) unplanned intubation prior to onset of postoperative pneumonia
Parameters:
(1) type of surgery
(2) age
(3) functional status
(4) weight change
(5) history of chronic obstructive pulmonary disease (COPD)
(6) type of anesthesia
(7) sensorium
(8) history of cerebrovascular accident (CVA, stroke)
(9) blood urea nitrogen level
(10) transfusion requirements
(11) type of surgery
(12) steroid use for a chronic condition
(13) current smoker (within past 1 year)
(14) alcohol intake
|
Parameter |
Finding |
Points |
|---|---|---|
|
type of surgery |
abdominal aortic aneurysm repair |
15 |
|
|
thoracic |
14 |
|
|
upper abdominal |
10 |
|
|
neck |
8 |
|
|
neurosurgery |
8 |
|
|
vascular |
3 |
|
|
other |
0 |
|
age |
>= 80 years of age |
17 |
|
|
70 – 79 years |
13 |
|
|
60 – 69 years |
9 |
|
|
50 – 59 years |
4 |
|
|
< 50 years |
0 |
|
functional status |
totally dependent |
10 |
|
|
partially dependent |
6 |
|
|
independent |
0 |
|
weight change |
> 10% in past 6 months |
7 |
|
|
< 10% in past 6 months |
0 |
|
|
unchanged |
0 |
|
|
weight gain |
0 |
|
history of COPD |
yes |
4 |
|
|
no |
0 |
|
type of anesthesia |
general |
4 |
|
|
not general |
0 |
|
sensorium |
impaired |
4 |
|
|
not impaired |
0 |
|
history of CVA |
yes |
4 |
|
|
no |
0 |
|
blood urea nitrogen level |
< 8 mg/dL |
4 |
| 8 – 21 mg/dL | 0 | |
|
|
22 – 30 mg/dL |
2 |
|
|
>= 30 mg/dL |
3 |
|
transfusion requirements |
> 4 units |
3 |
|
|
<= 4 units |
0 |
|
emergency surgery |
yes |
3 |
|
|
no |
0 |
|
use of steroids for a chronic condition |
yes |
3 |
|
|
no |
0 |
|
current smoker (in past year) |
yes |
3 |
|
|
no |
0 |
|
alcohol intake per day |
> 2 drinks per day during past 2 weeks |
2 |
|
|
<= 2 drinks per day |
0 |
from Table 4, page 853
total score =
= SUM(points for all 14 parameters)
Interpretation:
• minimum score: 0
• maximum score: 89
• The higher the score, the greater the risk of postoperative pneumonia.
|
Total Score |
Risk Class |
Rate of Pneumonia (Development Cohort) |
|---|---|---|
|
0 to 15 |
1 |
0.24% |
|
16 to 25 |
2 |
1.2% |
|
26 to 40 |
3 |
4.0% |
|
41 to 55 |
4 |
9.4% |
|
> 55 points |
5 |
15.3% |
from Table 5, page 853
Performance:
• C-statistic: 0.805 for development cohort and 0.817 for the validation cohort.
• Hosmer-Lemeshow goodness of fit statistic: 2.60
Purpose: To identify a patient at risk for postoperative pneumonia following major noncardiac surgery using the risk index of Arozullah et al from the VA.
Specialty: Infectious Diseases, Pulmonology
Objective: risk factors, severity, prognosis, stage
ICD-10: J15, J18, J95,
