PREDICTORS OF POSTOPERATIVE ATELECTASIS PNEUMONIA

描述：（改编自研究者摘要）术后肺部 并发症（PPC）是常见的，并与发病率增加， 死亡率、住院时间和资源利用。 肺不张 和肺炎占报告PPC的80%以上。 的目的 这项研究旨在开发预测模型，用于对临床风险进行分层， 严重肺不张和/或肺炎， 成人腹部和心胸外科的现有临床数据 人口 长期目标是开发预测模型，用于 指导术前和术后肺部护理的临床环境。 本研究的主要目的是开发、比较和验证模型， 预测临床显著肺不张和/或肺炎的风险 在腹部或心胸手术后，通过评估组合 手术期间不同时间段的风险因素 护理的一段时间。 次要目的是比较临床上 严重肺不张和/或肺炎， 患者之间的心胸手术和术后住院时间 有没有并发症的人 四家机构 将用于数据收集，目标人群为成年人， 正在接受择期腹部或心胸手术， 麻醉 目标样本量为1500名受试者，为期三年 期 将使用多标准定义来衡量 临床上显著的肺不张和肺炎， 发病率。 感兴趣的风险因素是：年龄增加， 术前认知功能水平，慢性肺病史， 既存共病，低或高体重指数（BMI），增加 术前住院时间，吸烟史，术前无 呼吸教育，高麻醉身体风险状态（阿萨），增加 麻醉持续时间、手术类型和位置、切口 插管/机械通气的方向和长度、持续时间 麻醉后阶段，疼痛管理，术后活动， 给予H2阻断剂/抗酸剂和存在鼻胃管。 将在手术前和每天收集每例受试者的数据 直到出院 Logistic回归分析将用于 检查单变量影响临床显著性的风险因素， 肺不张和肺炎，并制定和比较多变量 模型 将评价模型的效用和拟合优度。 一 将使用分裂样本技术进行模型验证。

DESCRIPTION: (Adapted from investigator's abstract) Postoperative pulmonary complications (PPCs) are frequent and associated with increased morbidity, mortality, hospital length of stay and resource utilization. Atelectasis and pneumonia account for >80% of reported PPCs. The objective of this study is to develop predictive models for stratifying the risk of clinically significant atelectasis and/or pneumonia using readily accessible or existing clinical data in an adult abdominal and cardiothoracic surgical population. The long term goal is to develop predictive model(s) for use in the clinical setting to guide preoperative and postoperative pulmonary care. The primary aim of this study is to develop, compare and validate models to predict the risk of clinically significant atelectasis and/or pneumonia following abdominal or cardiothoracic procedures by assessing combinations of risk factors available at differing time periods during the surgical episode of care. Secondary aims are to compare the incidence of clinically significant atelectasis and/or pneumonia following abdominal and cardiothoracic procedures and postoperative length of stay between patients who develop these complications and those who do not. Four institutions will be utilized for data collection and the target population is adults who are undergoing elective abdominal or cardiothoracic procedures with general anesthesia. The target sample size is 1500 subjects over a three year period. Multi-criteria definitions will be used to measure the outcomes of clinically significant atelectasis and pneumonia as not to overestimate the incidence. The risk factors of interest are: increased age, impaired preoperative level of cognitive function, history of chronic lung disease, preexisting comorbid diseases, low or high body mass index (BMI), increased preoperative length of stay, smoking history, absence of preoperative respiratory education, high anesthesia physical risk status (ASA), increased duration of anesthesia, type and location of surgical procedure, incision direction and length, duration of intubation/mechanical ventilation in the postanesthesia period, pain management, postoperative mobility, administration of H2 blockers/antacids and presence of a nasogastric tube. Data will be collected on each subject prior to surgery and on a daily basis until hospital discharge. Logistic regression analysis will be used to examine the risk factors for univariate effects on clinically significant atelectasis and pneumonia and to develop and compare the multivariate models. Models will be evaluated for utility and goodness-of-fit. A split-sample technique will be used for model validation.