Prediction of Postoperative Pulmonary Complications in a Population-based Surgical Cohort
Prediction of Postoperative Pulmonary Complications in a Population-based Surgical Cohort
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DOI：
10.1097/aln.0b013e3181fc6e0a
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发表时间：
2010-12-01
期刊：
影响因子：
8.8
通讯作者：
Sanchis, Joaquin
中科院分区：
文献类型：
--
作者：
Canet, Jaume;Gallart, Lluis;Sanchis, Joaquin
背景目前对术后肺部并发症（PPC）风险的认识依赖于严格选择患者和手术的研究。假设PPC的发生可以从一组减少的围手术期变量中预测，我们的目的是为广泛的手术人群开发一个预测指数。或区域麻醉的59家医院被随机选择用于这项前瞻性、多中心研究。主要结果是发生以下呼吸道感染、呼吸衰竭、支气管痉挛、肺不张、胸腔积液、气胸，或吸入性肺炎将队列随机分为发展子样本以构建逻辑回归模型和验证子样本。构建PPC预测指数。结果在研究的2，464名患者中，在123例（5%）患者中观察到252起事件，PPC患者的30天死亡率较高（19 5% 95% [CI] 12 5-26 5%）（0.5%，95%CI 0.2 ~ 0.8%）回归模型确定了术前动脉血氧饱和度低、前一个月急性呼吸道感染、年龄、术前贫血、上腹部或胸内手术手术时间至少2 h和急诊手术受试者工作特征曲线下面积为90%（95% CI 85-94%），开发子样本和88%（95% CI 84-93%）结论基于7个客观易评因素的危险指数具有较好的判别能力，可用于评价并将进一步研究重点放在改善患者护理的措施上
Background Current knowledge of the risk for postoperative pulmonary complications (PPCs) rests on studies that narrowly selected patients and procedures Hypothesizing that PPC occurrence could be predicted from a reduced set of perioperative variables, we aimed to develop a predictive index for a broad surgical populationMethods Patients undergoing surgical procedures given general, neuraxial, or regional anesthesia in 59 hospitals were randomly selected for this prospective, multicenter study The main outcome was the development of at least one of the following respiratory infection respiratory failure bronchospasm, atelectasis, pleural effusion, pneumothorax, or aspiration pneumonitis The cohort was randomly divided into a development subsample to construct a logistic regression model and a validation subsample A PPC predictive index was constructedResults Of 2,464 patients studied, 252 events were observed in 123 (5%) Thirty-day mortality was higher in patients with a PPC (19 5% 95% [CI] 12 5-26 5%) than in those without a PPC (0 5%, 95% CI 0 2-0 8%) Regression modeling identified seven independent risk factors low preoperative arterial oxygen saturation, acute respiratory infection during the previous month, age, preoperative anemia, upper abdominal or intrathoracic surgery surgical duration of at least 2 h and emergency surgery The area under the receiver operating characteristic curve was 90% (95% CI 85-94%) for the development subsample and 88% (95% CI 84-93%) for the validation subsampleConclusion The risk index based on seven objective easily assessed factors has excellent discriminative ability The index can be used to assess individual risk of PPC and focus further research on measures to improve patient care