Multivariable predictors of postoperative respiratory failure after general and vascular surgery: Results from the Patient Safety in Surgery Study
Multivariable predictors of postoperative respiratory failure after general and vascular surgery: Results from the Patient Safety in Surgery Study
复制标题
DOI：
10.1016/j.jamcollsurg.2007.02.070
复制
发表时间：
2007-06-01
影响因子：
5.2
通讯作者：
Khuri, Shukri F.
中科院分区：
文献类型：
--
作者：
Johnson, Robert G.;Arozullah, Ahsan M.;Khuri, Shukri F.
背景：术后呼吸衰竭（RF）与医院发病率、死亡率、费用和晚期死亡率的增加有关。我们开发并测试了一个模型，用于预测接受大血管和普通外科手术的患者术后RF的风险。该模型是早期模型的扩展，该模型仅从退伍军人事务部国家外科质量改进计划的男性患者人群中推导和测试。方法：从2001年10月到2004年9月，在14个学术医疗中心和128个退伍军人事务医疗中心接受血管和普通外科手术的患者被用来开发和测试术后RF的预测模型，Logistic回归分析。RF定义为术后机械通气超过48小时或意外重新插管。在180，359名患者中，（3.0%）发生术后RE，发现28个变量与RE独立相关。当前手术术语组，美国麻醉医师协会分级较高的患者，急诊手术，更复杂的手术（工作相对价值单位）、术前脓毒症和肌酐升高更容易发生RE。老年患者、男性患者、吸烟者和有充血性心力衰竭或COPD病史的患者，或两者兼而有之的患者也易发生RE。该模型的歧视（c-统计量）是优秀的，从开发（0.856）到验证（0.863）samples.Conclusions没有减少：该模型更新了以前验证的，是更广泛的适用。其用于预测术后RF风险，使预防措施或术前风险调整和干预的研究能够改善结局。
Background: Postoperative respiratory failure (RF) is associated with an increase in hospital morbidity, mortality, cost, and late mortality. We developed and tested a model to predict the risk of postoperative RF in patients undergoing major vascular and general surgical operations. This model is an extension of an earlier model that was derived and tested exclusively from a population of male patients from the Veterans Affairs National Surgical Quality Improvement Program.Methods: Patients undergoing vascular and general surgical procedures at 14 academic and 128 Veterans Affairs Medical Centers from October 2001 through September 2004 were used to develop and test a predictive model of postoperative RF using logistic regression analyses. RF was defined as postoperative mechanical ventilation for longer than 48 hours or unanticipated reintubation.Results: Of 180,359 patients, 5,389 (3.0%) experienced postoperative RE Twenty-eight variables were found to be independently associated with RE Current procedural terminology group, patients with a higher American Society of Anesthesiologists classification, emergency operations, more complex operation (work relative value units), preoperative sepsis, and elevated creatinine were more likely to experience RE Older patients, male patients, smokers, and those with a history of congestive heart failure or COPD, or both, were also predisposed. The model's discrimination (c-statistic) was excellent, with no decrement from development (0.856) to validation (0.863) samples.Conclusions: This model updates a previously validated one and is more broadly applicable. Its use to predict postoperative RF risk enables the study of preventative measures or preoperative risk adjustment and intervention to improve outcomes.