Original Articles

Multifactorial Risk Index for Predicting Postoperative Respiratory Failure in Men After Major Noncardiac Surgery

Arozullah, Ahsan M. MD, MPH*; Daley, Jennifer MD†; Henderson, William G. PhD‡; Khuri, Shukri F. MD§ for the National Veterans Administration Surgical Quality Improvement Program

Author Information

From the *Section of General Internal Medicine, University of Illinois College of Medicine, Chicago, Illinois; †Veterans Affairs Boston Healthcare System, West Roxbury, Harvard Medical School, and Massachusetts General Hospital/Partners Health Care System, Boston, Massachusetts; ‡Hines VA Cooperative Studies Program Coordinating Center, Hines, Illinois; §Veterans Affairs Boston Healthcare System, West Roxbury, Harvard Medical School, and Brigham and Women’s Hospital, Boston, Massachusetts

Correspondence: Ahsan M. Arozullah, MD, MPH, University of Illinois at Chicago, Section of General Internal Medicine (M/C 787), 840 S. Wood St., Chicago, IL 60612.

The National Veterans Administration Surgical Quality Improvement Program was funded by the Office of Patient Care Services and the Health Services Research and Development Service of the Department of Veterans Affairs.

Dr. Arozullah was an Ambulatory Care Fellow of the Department of Veterans Affairs during this project. Dr. Daley is a Senior Research Associate in the Career Development Award Program of the Veterans Affairs Health Services Research and Development Service.

E-mail: [email protected]

Accepted for publication February 2, 2000.

Annals of Surgery 232(2):p 242-253, August 2000.

Abstract

Objective 

To develop and validate a preoperative risk index for predicting postoperative respiratory failure (PRF).

Summary Background Data 

Respiratory failure is an important postoperative complication.

Method 

Based on a prospective cohort study, cases from 44 Veterans Affairs Medical Centers (n = 81,719) were used to develop the models. Cases from 132 Veterans Affairs Medical Centers (n = 99,390) were used as a validation sample. PRF was defined as mechanical ventilation for more than 48 hours after surgery or reintubation and mechanical ventilation after postoperative extubation. Ventilator-dependent, comatose, do not resuscitate, and female patients were excluded.

Results 

PRF developed in 2,746 patients (3.4%). The respiratory failure risk index was developed from a simplified logistic regression model and included abdominal aortic aneurysm repair, thoracic surgery, neurosurgery, upper abdominal surgery, peripheral vascular surgery, neck surgery, emergency surgery, albumin level less than 30 g/L, blood urea nitrogen level more than 30 mg/dL, dependent functional status, chronic obstructive pulmonary disease, and age.

Conclusions 

The respiratory failure risk index is a validated model for identifying patients at risk for developing PRF and may be useful for guiding perioperative respiratory care.

© 2000 Lippincott Williams & Wilkins, Inc.

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