Simple assessment predicts need for reintubation
medwireNews: A simple scoring system allows anesthesiologists to reliably predict severe postoperative respiratory complications, researchers report in Anesthesiology.
"On the basis of preoperatively available characteristics, we developed a simple score (score for prediction of postoperative respiratory complications [SPORC]), which was highly predictive of postextubation respiratory failure leading to reintubation," write Matthias Eikermann (Massachusetts General Hospital, Boston, USA) and colleagues.
Eikermann's team looked at 29,924 patients (mean 55 years old) who had 33,769 surgical procedures between January 2007 and April 2010, with reintubation occurring in 137 (0.41%) of the cases (n=65).
The time between primary extubation and reintubation was a median of 6.4 hours, with pulmonary edema, atelectasis, pneumonia, impaired brain function, and aspiration being the most common reasons for postoperative respiratory failure and reintubation.
Reintubation within the first 3 days after surgery was associated with a notable 72-fold increase in risk for in-hospital mortality. Specifically, 22 (16%) patients died subsequent to reintubation, a significantly higher mortality rate than the 0.26% of non-reintubated patients.
The reintubated cases were older on average (64 vs 55 years) and had higher comorbidity scores and worse overall health before surgery per the American Society of Anesthesiologist (ASA) score, which is often a predictor for postextubation respiratory failure and mortality.
Multivariate analysis calculated that an ASA score of 3 or more, emergency procedures, referred high-risk service, a history of congestive heart failure, and chronic pulmonary disease were the strongest independent predictors for postoperative reintubation.
The final scoring system that Eikermann and team developed is based on these predictors and has a total possible score ranging from 0 to 11. Patients reintubated within the first 3 postoperative days had a median score of 4, which was significantly higher than those who did not (0).
For every 1-point increase in the score, the odds for reintubation increased 1.7-fold while the mortality odds would heighten 1.8-fold. The score yielded an area under the receiver-operating characteristic curve of 0.81 (where 1.00 is perfect discrimination).
"[T]he SPORC represents a simple approach that can be used by clinicians to assess the risk of postextubation respiratory failure as soon as patients are scheduled for surgery," conclude the authors.
In an accompanying editorial, Amy Young and Satya Krishna Ramachandran (University of Michigan, Ann Arbor, USA) emphasize the strength of Eikermann at al's identification of targetable risk conditions of postoperative respiratory failure.
"In doing so, they have lit a path of discovery toward greater efficiency of screening," they conclude.
medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013
By Peter Sergo, medwireNews Reporter