Postoperative Respiratory Failure Risk Calculator | Medical Algorithm

Description

Johnson et al developed a model for predicting respiratory failure following general and vascular surgery. This can help to identify patients who may require alternative or more aggressive management. The authors are from multiple hospitals in the United States participating in the Patient Safety in Surgery Study and the Veterans Affairs National Surgical Quality Improvement Program (NSQIP).

Parameters:

(1) ASA class

(2) emergency surgery

(3) work relative value unit (RVU)

(4) preoperative albumin in g/dL

(5) type of surgical procedure

(6) preoperative sepsis

(7) preoperative creatinine in mg/dL

(8) history of severe COPD

(9) ascites

(10) dyspnea

(11) impaired senorium

(12) preoperative serum total bilirubin in mg/dL

(13) recent daily alcohol intake

(14) bleeding disorder

(15) age in years

(16) preoperative white blood cell count

(17) preoperative serum sodium in mmol/L

(18) percent weight loss

(19) preoperative acute renal failure

(20) gender

(21) congestive heart failure in the month prior to surgery

(22) current smoker

(23) preoperative platelet count

(24) cerebrovascular accident or stroke with neurologic deficit

(25) cerebrovascular accident or stroke without neurologic deficit

(26) wound class

(27) preoperative serum SGOT in IU/L

(28) preoperative hematocrit

Parameter	Finding	Points
ASA class	ASA 1 or 2	0
	ASA 3	3
	ASA 4 or 5	5
emergency procedure	no	0
	yes	2
work RVU	< 10	0
	10 to 17	2
	> 17	4
preoperative albumin	<= 3.5 g/dL	1
	> 3.5 g/dL	0
type of surgical procedure	hernia	0
	skin	1
	respiratory and hemic	3
	heart or aneurysm	2
	mouth or palate	7
	stomch or intestine	2
	endocrine	2
preperative sepsis	no	0
	yes	2
preoperative serum creatinine	< 1.5 mg/dL	0
	>= 1.5 mg/dL	2
history of severe COPD	no	0
	yes	2
ascites	no	0
	yes	2
dyspnea	no	0
	yes	1
impaired sensorium	no	0
	yes	1
preoperative total bilirubin	<= 1.0 mg/dL	0
	> 1.0 mg/dL	1
average recent alcohol intake	<= 2 drinks/day in past 2 weeks	0
	> 2 drinks/day in past 2 weeks	1
bleeding disorder	no	0
	yes	1
age in years	< 40 years	0
	>= 40 years	2
preoperative white blood cell count	< 2,500 per µL	1
	2,500 to 10,000 per µL	0
	> 10,000 per µL	1
preoperative serum sodium	<= 145 mmol/L	0
	> 145 mmol/L	2
percent weight loss	<= 10%	0
	> 10%	1
preoperative acute renal failure	no	0
	yes	2
gender	female	0
	male	1
congestive heart failure in past month	no	0
	yes	1
smoker	no	0
	yes	1
preoperative platelet count	> 150,000 per µL	0
	<= 150,000 per µL	1
wound class	clean	0
	not clean	1
preoperative SGOT	<= 40 U/L	0
	> 40 U/L	1
preoperative hematocrit	> 38 percent	0
	<= 38 percent	1
CVA or stroke without neurologic deficit	no	0
	yes	1
CVA or stroke with neurologic deficit	no	0
	yes	1

total score =

= SUM(points for all 28 parameters)

Interpretation:

• minimum score: 0

• maximum score: 49

• The higher the score the greater the risk of respiratory failure following surgery.

Total Score	Risk Group	Postoperative Respiratory Failure
0 to 7	low	0.08%
8 to 12	medium	1%
13 or more	high	7%

Limitations:

• There are a lot of risk factors lumped into the high risk group.

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Description

Specialty

Objective

ICD-10

Respiratory Failure Following General & Vascular Surgery Risk Model

Purpose: To identify a patient at risk for respiratory failure following general or vascular surgery using the model of Johnson et al.

Description

Specialty

Objective

ICD-10