Development and validation of a multifactorial risk index for predicting postoperative pneumonia after major noncardiac surgery
Development and validation of a multifactorial risk index for predicting postoperative pneumonia after major noncardiac surgery
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DOI：
10.7326/0003-4819-135-10-200111200-00005
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发表时间：
2001-11-20
影响因子：
39.2
通讯作者：
Daley, J
中科院分区：
文献类型：
--
作者：
Arozullah, AM;Khuri, SF;Daley, J
背景：肺炎是一种常见的术后并发症，具有很高的发病率和死亡率。目的：建立并验证预测术后肺炎的术前风险指标。设计：前瞻性队列研究，结果评估基于图表回顾。环境：100个退伍军人事务医疗中心进行大手术。患者：风险指数是根据1997年9月1日至1999年8月31日期间接受重大非心脏手术的160 805名患者的数据制定的，并通过1995年9月1日至1997年8月31日期间接受手术的155 266名患者的数据进行验证。排除术前肺炎、呼吸机依赖和术后呼吸衰竭后发生的肺炎患者。测量方法：术后肺炎的定义采用疾病控制与预防中心对院内肺炎的定义。结果：共2466例（1.5%）患者发生肺炎，术后30天死亡率为21%。术后肺炎风险指数包括手术类型（腹主动脉瘤修复、胸外科、上腹部、颈部、血管和神经外科）、年龄、功能状态、体重减轻、慢性阻塞性肺疾病、全身麻醉、感觉功能受损、脑血管意外、血尿素氮水平、输血、急诊手术、长期使用类固醇、吸烟和饮酒。采用风险指数评分法将患者分为5个风险等级。0至15个风险点的肺炎发病率为0.2%，16至25个风险点的肺炎发病率为1.2%，26至40个风险点的肺炎发病率为4.0%，41至55个风险点的肺炎发病率为9.4%，超过55个风险点的肺炎发病率为15.3%。发展组的c统计量为0.805，验证组的c统计量为0.817。结论：术后肺炎风险指数可识别有术后肺炎风险的患者，可指导围手术期呼吸护理。
Background: Pneumonia is a common postoperative complication associated with substantial morbidity and mortality.Objective: To develop and validate a preoperative risk index for predicting postoperative pneumonia.Design: Prospective cohort study with outcome assessment based on chart review.Setting: 100 Veterans Affairs Medical Centers performing major surgery.Patients: The risk index was developed by using data on 160 805 patients undergoing major noncardiac surgery between I September 1997 and 31 August 1999 and was validated by using data on 155 266 patients undergoing surgery between 1 September 1995 and 31 August 1997. Patients with preoperative pneumonia, ventilator dependence, and pneumonia that developed after postoperative respiratory failure were excluded.Measurements: Postoperative pneumonia was defined by using the Centers for Disease Control and Prevention definition of nosocomial pneumonia.Results: A total of 2466 patients (1.5%) developed pneumonia, and the 30-day postoperative mortality rate was 21%. A postoperative pneumonia risk index was developed that included type of surgery (abdominal aortic aneurysm repair, thoracic, upper abdominal, neck, vascular, and neurosurgery), age, functional status, weight loss, chronic obstructive pulmonary disease, general anesthesia, impaired sensorium, cerebral vascular accident, blood urea nitrogen level, transfusion, emergency surgery, long-term steroid use, smoking, and alcohol use. Patients were divided into five risk classes by using risk index scores. Pneumonia rates were 0.2% among those with 0 to 15 risk points, 1.2% for those with 16 to 25 risk points, 4.0% for those with 26 to 40 risk points, 9.4% for those with 41 to 55 risk points, and 15.3% for those with more than 55 risk points. The C-statistic was 0.805 for the development cohort and 0.817 for the validation cohort.Conclusions: The postoperative pneumonia risk index identifies patients at risk for postoperative pneumonia and may be useful in guiding perioperative respiratory care.