Tanyong Pipanmekaporn1,2, Nutchanart Bunchungmongkol1, Yodying Punjasawadwong1, Worawut Lapisatepun1, Apichat Tantraworasin2,3, Surasak Saokaew4,5,6,7. 1. 1 Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. 2. 2 Clinical Epidemiology and Clinical Statistic Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. 3. 3 Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. 4. 4 Center of Health Outcomes Research and Therapeutic Safety, School of Pharmaceutical Sciences, University of Phayao, Thailand. 5. 5 Center of Pharmaceutical Outcome Research (CPOR), Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand. 6. 6 Unit of Excellence on Herbal Medicine, School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand. 7. 7 School of Phamacy, Monash University Malaysia, Malaysia.
Abstract
BACKGROUND: Respiratory complications are some of the most common complications following thoracic surgery and can lead to higher perioperative morbidity and mortality. The purpose of this study was to develop a simple clinical score for prediction of respiratory complications after thoracic surgery, and determine the internal validity. METHODS: In this retrospective cohort study, all consecutive patients were aged 18 years and over and undergoing non-cardiac thoracic surgery at a tertiary-care university hospital. Respiratory complications included bronchospasm, atelectasis, pneumonia, respiratory failure, and adult respiratory distress syndrome within 30 days of surgery or before discharge. RESULTS: A total of 1488 patients were included over a 7-year period, and 15.8% (235 of 1488 patients) developed respiratory complications. The significant predictors of respiratory complications were chronic obstructive pulmonary disease, American Society of Anesthesiologist physical status ≥ 3, right-sided surgery, duration of surgery longer than 180 min, preoperative arterial oxygen saturation on room air < 96%, and open thoracotomy. The area under receiving operating characteristic curve was 0.78 (95% confidence interval: 0.75-0.82) and 0.76 (95% confidence interval: 0.70-0.83) for the derivation and validation cohorts, respectively. The model was well calibrated with a Hosmer-Lemeshow goodness-of-fit of 7.32 ( p = 0.293). CONCLUSIONS: This study developed and internally validated a simple clinical risk score for prediction of respiratory complications following thoracic surgery. This score can be used to stratify high-risk patients, address modifiable risk factors for respiratory complications, and provide preventive strategies for improving postoperative outcomes.
BACKGROUND: Respiratory complications are some of the most common complications following thoracic surgery and can lead to higher perioperative morbidity and mortality. The purpose of this study was to develop a simple clinical score for prediction of respiratory complications after thoracic surgery, and determine the internal validity. METHODS: In this retrospective cohort study, all consecutive patients were aged 18 years and over and undergoing non-cardiac thoracic surgery at a tertiary-care university hospital. Respiratory complications included bronchospasm, atelectasis, pneumonia, respiratory failure, and adult respiratory distress syndrome within 30 days of surgery or before discharge. RESULTS: A total of 1488 patients were included over a 7-year period, and 15.8% (235 of 1488 patients) developed respiratory complications. The significant predictors of respiratory complications were chronic obstructive pulmonary disease, American Society of Anesthesiologist physical status ≥ 3, right-sided surgery, duration of surgery longer than 180 min, preoperative arterial oxygen saturation on room air < 96%, and open thoracotomy. The area under receiving operating characteristic curve was 0.78 (95% confidence interval: 0.75-0.82) and 0.76 (95% confidence interval: 0.70-0.83) for the derivation and validation cohorts, respectively. The model was well calibrated with a Hosmer-Lemeshow goodness-of-fit of 7.32 ( p = 0.293). CONCLUSIONS: This study developed and internally validated a simple clinical risk score for prediction of respiratory complications following thoracic surgery. This score can be used to stratify high-risk patients, address modifiable risk factors for respiratory complications, and provide preventive strategies for improving postoperative outcomes.