Johnson et al developed a score for predicting respiratory failure following general or vascular surgery. The authors are from the National Surgical Quality Improvement Program (NSQIP), Veterans Administration and multiple hospitals in the United States.
Patient selection: general and vascular surgery
Outcome: postoperative respiratory failure
Parameters:
(1) ASA class
(2) emergency surgery
(3) work RVU for procedure
(4) preoperative serum albumin in g/dL
(5) type of surgery
(6) preoperative sepsis
(7) preoperative serum creatinine
(8) history of severe COPD
(9) ascites
(10) dyspnea
(11) impaired sensorium
(12) preoperative serum total bilirubin in mg/dL
(13) number of alcohol drinks per day in 2 weeks prior to admission
(14) bleeding disorder
(15) age in years
(16) preoperative white blood cell count per µL
(17) preoperative serum sodium in mmol/L
(18) weight loss in percent
(19) preoperative acute renal failure
(20) gender
(21) congestive heart failure in month before operation
(22) smoker
(23) preoperative platelet count per µL
(24) CVA or stroke
(25) wound class
(26) preoperative SGOT (AST) in IU/L
(27) preoperative hematocrit in percent
|
Parameter |
Finding |
Points |
|
ASA class |
1 or 2 |
0 |
|
|
3 |
3 |
|
|
4 or 5 |
5 |
|
emergency surgery |
no |
0 |
|
|
yes |
2 |
|
work RVU |
< 10 |
0 |
|
|
10 to 17 |
2 |
|
|
> 17 |
4 |
|
preoperative serum albumin |
> 3.5 g/dL |
0 |
|
|
<= 3.5 g/dL |
1 |
|
type of surgery |
hernia |
0 |
|
|
integumentary |
1 |
|
|
respiratory and hemic |
3 |
|
|
heart |
2 |
|
|
aneurysm |
2 |
|
|
mouth or palate |
7 |
|
|
stomach or intestines |
2 |
|
|
endocrine |
2 |
|
preoperative sepsis |
no |
0 |
|
|
yes |
2 |
|
preoperative serum creatinine |
< 1.5 |
0 |
|
|
>= 1.5 |
2 |
|
history of COPD |
no |
0 |
|
|
yes |
2 |
|
ascites |
no |
0 |
|
|
yes |
2 |
|
dyspnea |
no |
0 |
|
|
yes |
1 |
|
impaired sensorium |
no |
0 |
|
|
yes |
1 |
|
preoperative bilirubin |
<= 1.0 mg/dL |
0 |
|
|
> 1.0 mg/dL |
1 |
|
alcoholic drinks |
0 to 2 per day |
0 |
|
|
> 2 per day |
1 |
|
bleeding disorder |
no |
0 |
|
|
yes |
1 |
|
age in years |
< 40 years |
0 |
|
|
40 to 65 years |
2 |
|
|
> 65 years |
2 |
|
preoperative WBC |
< 2,500 |
1 |
|
|
2,500 to 10,000 |
0 |
|
|
> 10,000 |
1 |
|
preoperative sodium |
<= 145 |
0 |
|
|
> 145 |
2 |
|
weight loss |
<= 10% |
0 |
|
|
> 10% |
1 |
|
preoperative ARF |
no |
0 |
|
|
yes |
2 |
|
gender |
male |
1 |
|
|
female |
0 |
|
CHF |
no |
0 |
|
|
yes |
1 |
|
smoker |
no |
0 |
|
|
yes |
1 |
|
preoperative platelet count |
> 150,000 |
0 |
|
|
<= 150,000 |
1 |
|
CVA or stroke |
none |
0 |
|
|
without deficit |
1 |
|
|
with deficit |
1 |
|
wound |
clean |
0 |
|
|
clean/contaminated |
1 |
|
|
contaminated |
1 |
|
|
infected |
1 |
|
preoperative SGOT |
<= 40 |
0 |
|
|
> 40 |
1 |
|
preoperative hematocrit |
> 38 |
0 |
|
|
<= 38 |
1 |
total score =
= SUM(points for all 27 parameters)
Interpretation:
• minimum score: 0
• maximum score: 48
• The higher the score the greater the risk for postoperative respiratory failure.
|
Score |
Risk Group |
Respiratory Failure |
|
0 to 7 |
low |
0.2% |
|
8 to 12 |
medium |
1% |
|
>= 13 |
high |
7% |
If the data in Figure 6 is plotted.
|
Score |
Respiratory Failure |
|
<= 7 |
0% |
|
7 to 12 |
(0.3543 * (score)) - 2.532 |
|
12 to 20 |
(0.189 * ((score)^2)) - (4.493 * (score)) + 28.69 |
|
20 to 27 |
(4.108 * (score)) - 67.76 |
|
> 27 |
> 43% |
Performance:
• The area under the ROC curve is 0.86.
Specialty: Anesthesiology
