Multifactorial risk index for predicting postoperative respiratory failurein men after major noncardiac surgery

Objective To develop and validate a preoperative risk index for predicting postoperat ive respiratory failure (PRF). Summary Background Data Respiratory failure is an important postoperative complication. Method Based on a prospective cohort study, cases from 44 Veterans Affairs Medical Centers (n = 81,719) were used to develop the models. Cases from 132 Veter ans Affairs Medical Centers (n = 99,390) were used as a validation sample. PRF was defined as mechanical ventilation for more than 48 hours after surg ery or reintubation and mechanical Ventilation after post-operative extubat ion. Ventilator-dependent, comatose, do not resuscitate, and female patient s were excluded. Results PRF developed in 2,746 patients (3.4%). The respiratory failure risk index was developed from a simplified logistic regression model and included abdo minal aortic aneurysm repair, thoracic surgery, neurosurgery, upper abdomin al surgery, peripheral vascular surgery, neck surgery, emergency surgery, a lbumin level less than 30 g/L, blood urea nitrogen level more than 30 mg/dL , dependent functional status, chronic obstructive pulmonary disease, and a ge. Conclusions The respiratory failure risk index is a validated model for identifying pat ients at risk for developing PRF and may be useful for guiding perioperativ e respiratory care.