Foster et al reported a score for predicting the risk of pulmonary complications after a hepatectomy. This can help to identify a patient who may benefit from more aggressive management. The authors are from Virginia Commonwealth University and the University of Virginia.
Patient selection: hepatectomy
Outcome: 30-day risk of unplanned reintubation, postoperative pneumonia, failure to liberate from mechanical ventilation within 48 hours of being intubated
Parameters:
(1) age in years
(2) sex
(3) serum albumin prior to surgery in g/dL
(4) ASA class
(5) history of severe COPD
(6) smoking status
(7) functional dependency
(8) total operation time in minutes
(9) preoperative sepsis
(10) hypertension requiring medication
Parameter |
Finding |
Points |
age |
< 60 years |
0 |
|
60 to 69 years |
21 |
|
70 to 79 years |
44 |
|
>= 80 years |
78 |
sex |
female |
0 |
|
male |
23 |
serum albumin |
< 3.5 g/dL |
50 |
|
>= 3.5 g/dL |
0 |
ASA class |
I or II |
0 |
|
III, IV or V |
53 |
history of severe COPD |
no |
0 |
|
yes |
59 |
smoking status |
current or within past year |
43 |
|
stopped > 1 year |
0 |
|
never |
0 |
functional dependency |
none |
0 |
|
partial or total |
82 |
operation time |
< 156 minutes |
0 |
|
156 to 220 minutes |
10 |
|
221 to 305 minutes |
59 |
|
>= 306 |
114 |
preoperative sepsis |
no |
0 |
|
yes |
73 |
hypertension requiring medications |
no |
0 |
|
yes |
25 |
total score =
= SUM(points for all 10 parameters)
Interpretation:
• minimum score: 0
• maximum score: 600
• The higher the score the greater the risk of postoperative pulmonary complications.
Score |
Pulmonary Complications |
< 117 |
1.9% |
117 to 161 |
4.4-4.9% |
162 to 228 |
8.1-8.8% |
> 228 |
16.9-17.2% |
Specialty: Pulmonology, Anesthesiology, Gastroenterology