Foster et al reported a score for predicting the risk of pulmonary complications after a lung resection. This can help to identify a patient who may benefit from more aggressive management. The authors are from Virginia Commonwealth University and the University of Virginia.
Patient selection: lung resection
Outcome: 30-day risk of unplanned reintubation, postoperative pneumonia, failure to liberate from mechanical ventilation within 48 hours of being intubated
Parameters:
(1) age in years
(2) sex
(3) serum albumin prior to surgery in g/dL
(4) ASA class
(5) history of severe COPD
(6) smoking status
(7) dyspnea
(8) functional dependency
(9) congestive heart failure in the 30 days prior to surgery
(10) total operation time in minutes
(11) preoperative sepsis
(12) preoperative anemia (hematocrit < 37% for male; < 35% for female)
|
Parameter
|
Finding
|
Points
|
|
age
|
< 60 years
|
0
|
|
|
60 to 69 years
|
10
|
|
|
70 to 79 years
|
29
|
|
|
>= 80 years
|
58
|
|
sex
|
female
|
0
|
|
|
male
|
26
|
|
serum albumin
|
< 3.5 g/dL
|
62
|
|
|
>= 3.5 g/dL
|
0
|
|
ASA class
|
I or II
|
0
|
|
|
III, IV or V
|
54
|
|
history of severe COPD
|
no
|
0
|
|
|
yes
|
67
|
|
smoking status
|
current or within past year
|
42
|
|
|
stopped > 1 year
|
0
|
|
|
never
|
0
|
|
dyspnea
|
none or mild
|
0
|
|
|
moderate or at rest
|
24
|
|
functional dependency
|
none
|
0
|
|
|
partial or total
|
95
|
|
congestive heart failure
|
no
|
0
|
|
|
yes
|
80
|
|
operation time
|
< 90 minutes
|
0
|
|
|
90 to 139 minutes
|
36
|
|
|
140 to 202 minutes
|
56
|
|
|
>= 203
|
94
|
|
preoperative sepsis
|
no
|
0
|
|
|
yes
|
122
|
|
preoperative anemia
|
no
|
0
|
|
|
yes
|
38
|
total score =
= SUM(points for all 12 parameters)
Interpretation:
• minimum score: 0
• maximum score: 607
• The higher the score the greater the risk of postoperative pulmonary complications.
|
Score
|
Pulmonary Complications
|
|
< 111
|
1.5-2.4%
|
|
111 to 172
|
4.4-4.9%
|
|
173 to 231
|
8.8-9.1%
|
|
> 231
|
17.2-17.8%
|
