Takesue et al reported a calculator for predicting the risk of pneumonia following gastrointestinal surgery. The authors are from the Japanese Society of Gastroenterological Surgery in Tokyo.
Patient selection: adult undergoing gastrointestinal surgery
Parameters:
(1) age category
(2) sex
(3) COPD
(4) cerebrovascular disease
(5) diabetes
(6) ascites
(7) hypertension
(8) bleeding disorder
(9) ASA status
(10) previous percutaneous coronary intervention (PCI)
(11) chronic steroid use
(12) need for assistance with activities of daily living (ADL)
(13) tobacco use (Brinkman index based on years smoking and number cigarettes smoked per day))
(14) weight loss > 10%
(15) preoperative transfusion
(16) SIRS with infection
(17) surgical acuity
(18) hematocrit
(19) serum albumin in g/dL
(20) serum AST in IU/L
(21) serum ALP in IU/L
(22) serum BUN in mg/dL
(23) serum sodium in mmol/L
(24) duration of surgery
(25) blood loss during surgery
|
Parameter |
Finding |
Points |
|
age in years |
< 60 years |
0.257 |
|
|
60 to 64 |
0.514 |
|
|
65 to 69 |
0.771 |
|
|
70 to 74 |
1.028 |
|
|
75 to 79 |
1.285 |
|
|
>= 80 |
1.542 |
|
sex |
male |
0.554 |
|
|
female |
0 |
|
COPD |
no |
0 |
|
|
yes |
0.713 |
|
cerebrovascular disease |
no |
0 |
|
|
yes |
0.474 |
|
diabetes |
no |
0 |
|
|
yes |
0.070 |
|
ascites |
no |
0 |
|
|
yes |
0.116 |
|
hypertension |
no |
0 |
|
|
yes |
0.108 |
|
bleeding disorder |
no |
0 |
|
|
yes |
0.121 |
|
ASA status |
1 or 2 |
0 |
|
|
3, 4 or 5 |
0.348 |
|
previous PCI |
no |
0 |
|
|
yes |
0.263 |
|
chronic steroid use |
no |
0 |
|
|
yes |
0.486 |
|
need for assistance in ADL |
no |
0 |
|
|
yes |
0.726 |
|
heavy tobacco use |
no |
0 |
|
|
yes (Brinkman index > 400) |
0.266 |
|
weight loss |
<= 10% |
0 |
|
|
> 10% |
0.251 |
|
preoperative transfusion |
no |
0 |
|
|
yes |
0.185 |
|
SIRS with infection |
no |
0 |
|
|
yes |
0.575 |
|
surgical acuity |
emergency |
0.476 |
|
|
elective or urgent |
0 |
|
hematocrit |
> 48% AND male |
0.164 |
|
|
> 42% AND female |
0.164 |
|
|
other |
0 |
|
serum albumin |
>= 2.5 g/dL |
0 |
|
|
< 2.5 g/dL |
0.311 |
|
serum AST |
<= 35 IU/L |
0 |
|
|
> 35 IU/L |
0.123 |
|
serum ALP |
<= 340 IU/L |
0 |
|
|
> 340 IU/L |
0.136 |
|
serum BUN |
<= 25 mg/dL |
0 |
|
|
> 25 mg/dL |
0.208 |
|
serum sodium |
< 138 mmol/L |
0.155 |
|
|
>= 138 mmol/L |
0 |
|
surgical duration |
<= 75th percentile |
0 |
|
|
> 75th percentile |
0.313 |
|
blood loss |
<= 75th percentile |
0 |
|
|
> 75th percentile |
0.379 |
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0.257
• maximum score: 9.063
• The higher the score the greater the risk of postoperative pneumonia.
value of X =
= (1.002 * (score)) - 6.46
probability of postoperative pneumonia =
= 1 / (1 + EXP((-1) *X ))
Performance:
• The area under the ROC curve is 0.82.
Specialty: Infectious Diseases
