Description

Johnson et al developed a model for predicting respiratory failure following general and vascular surgery. This can help to identify patients who may require alternative or more aggressive management. The authors are from multiple hospitals in the United States participating in the Patient Safety in Surgery Study and the Veterans Affairs National Surgical Quality Improvement Program (NSQIP).


Parameters:

(1) ASA class

(2) emergency surgery

(3) work relative value unit (RVU)

(4) preoperative albumin in g/dL

(5) type of surgical procedure

(6) preoperative sepsis

(7) preoperative creatinine in mg/dL

(8) history of severe COPD

(9) ascites

(10) dyspnea

(11) impaired senorium

(12) preoperative serum total bilirubin in mg/dL

(13) recent daily alcohol intake

(14) bleeding disorder

(15) age in years

(16) preoperative white blood cell count

(17) preoperative serum sodium in mmol/L

(18) percent weight loss

(19) preoperative acute renal failure

(20) gender

(21) congestive heart failure in the month prior to surgery

(22) current smoker

(23) preoperative platelet count

(24) cerebrovascular accident or stroke with neurologic deficit

(25) cerebrovascular accident or stroke without neurologic deficit

(26) wound class

(27) preoperative serum SGOT in IU/L

(28) preoperative hematocrit

 

Parameter

Finding

Points

ASA class

ASA 1 or 2

0

 

ASA 3

3

 

ASA 4 or 5

5

emergency procedure

no

0

 

yes

2

work RVU

< 10

0

 

10 to 17

2

 

> 17

4

preoperative albumin

<= 3.5 g/dL

1

 

> 3.5 g/dL

0

type of surgical procedure

hernia

0

 

skin

1

 

respiratory and hemic

3

 

heart or aneurysm

2

 

mouth or palate

7

 

stomch or intestine

2

 

endocrine

2

preperative sepsis

no

0

 

yes

2

preoperative serum creatinine

< 1.5 mg/dL

0

 

>= 1.5 mg/dL

2

history of severe COPD

no

0

 

yes

2

ascites

no

0

 

yes

2

dyspnea

no

0

 

yes

1

impaired sensorium

no

0

 

yes

1

preoperative total bilirubin

<= 1.0 mg/dL

0

 

> 1.0 mg/dL

1

average recent alcohol intake

<= 2 drinks/day in past 2 weeks

0

 

> 2 drinks/day in past 2 weeks

1

bleeding disorder

no

0

 

yes

1

age in years

< 40 years

0

 

>= 40 years

2

preoperative white blood cell count

< 2,500 per µL

1

 

2,500 to 10,000 per µL

0

 

> 10,000 per µL

1

preoperative serum sodium

<= 145 mmol/L

0

 

> 145 mmol/L

2

percent weight loss

<= 10%

0

 

> 10%

1

preoperative acute renal failure

no

0

 

yes

2

gender

female

0

 

male

1

congestive heart failure in past month

no

0

 

yes

1

smoker

no

0

 

yes

1

preoperative platelet count

> 150,000 per µL

0

 

<= 150,000 per µL

1

wound class

clean

0

 

not clean

1

preoperative SGOT

<= 40 U/L

0

 

> 40 U/L

1

preoperative hematocrit

> 38 percent

0

 

<= 38 percent

1

CVA or stroke without neurologic deficit

no

0

 

yes

1

CVA or stroke with neurologic deficit

no

0

 

yes

1

 

total score =

= SUM(points for all 28 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 49

• The higher the score the greater the risk of respiratory failure following surgery.

 

Total Score

Risk Group

Postoperative Respiratory Failure

0 to 7

low

0.08%

8 to 12

medium

1%

13 or more

high

7%

 

Limitations:

• There are a lot of risk factors lumped into the high risk group.


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