The development and validation of the Score for the Prediction of Postoperative Respiratory Complications (SPORC‐2) to predict the requirement for early postoperative tracheal re‐intubation: a hospital registry study. (20th June 2019)

• Record Type: Journal Article
• Authors: Lukannek, C.; Shaefi, S.; Platzbecker, K.; Raub, D.; Santer, P.; Nabel, S.; Lecamwasam, H.S.; Houle, T.T.; Eikermann, M.
• Is Part Of: Anaesthesia. Volume 74:Number 9(2019)
• Page Start: 1165
• Page End: 1174
• Publication Date: 2019-06-20
• Subjects: clinical epidemiology -- critical care -- postoperative ventilation -- quality measures -- risk assessment; Anesthesia -- Periodicals; 617.96
• DOI: 10.1111/anae.14742
• Languages: English
• ISSNs: 0003-2409

Abstract

Summary: Postoperative pulmonary complications are associated with an increase in mortality, morbidity and healthcare utilisation. The Agency for Healthcare Research and Quality recommends risk assessment for postoperative respiratory complications in patients undergoing surgery. In this hospital registry study of adult patients undergoing non‐cardiac surgery between 2005 and 2017 at two independent healthcare networks, a prediction instrument for early postoperative tracheal re‐intubation was developed and externally validated. This was based on the development of the Score for Prediction Of Postoperative Respiratory Complications. For predictor selection, stepwise backward logistic regression and bootstrap resampling were applied. Development and validation cohorts were represented by 90, 893 patients at Partners Healthcare and 67, 046 patients at Beth Israel Deaconess Medical Center, of whom 699 (0.8%) and 587 (0.9%) patients, respectively, had their tracheas re‐intubated. In addition to five pre‐operative predictors identified in the Score for Prediction Of Postoperative Respiratory Complications, the final model included seven additional intra‐operative predictors: early post‐tracheal intubation desaturation; prolonged duration of surgery; high fraction of inspired oxygen; high vasopressor dose; blood transfusion; the absence of volatile anaesthetic use; and the absence of lung‐protective ventilation. The area under the receiver operating characteristic curve for the new score was significantly greater than that of the original Score for Prediction Of Postoperative Respiratory Complications (0.84 [95%CI 0.82–0.85] vs. 0.76 [95%CI 0.75–0.78], respectively; p < 0.001). This may allow clinicians to develop and implement strategies to decrease the risk of early postoperative tracheal re‐intubation. Abstract : 수술 후 폐합병증은 사망률과 병적상태(mortality and morbidity) 및 의료서비스 이용의 증가와 연관성을 가진다. Agency for Healthcare Research and Quality는 수술 환자 를 대상으로 수술 후 폐합병증 위험 평가를 권고하고 있다. 2005‐2017년 동안 두 개의 독립적인 의료서비스 네트워크에 서 비심장수술을 받은 성인 환자를 대상으로 시행한 병원 레 지스트리 연구를 통해 수술 후 조기 기관 재삽관을 위한 예측 도구를 개발하였으며 외부적으로 검증하였다. 이는 Score for Prediction Of Postoperative Respiratory Complication (SPORC)을 기반으로 하였다. 예측인자 선별은 단계적 후진제 거법을 이용한 로지스틱 회귀분석(stepwise backward logistic regression)과 부트스트랩 재표본추출(bootstrap resampling)을 적용하였다. 개발 및 검증 코호트는 Partners Healthcare의 환자 90, 893명과 Beth Israel Deaconess Medical Center의 67, 046명 환자로 구성되었으며, 이 중 수술 후 기관 삽관을 재시행한 환자는 각각 669명(0.8%)과 587명 (0.9%)으로 나타났다. SPORC에서 활용한 5개의 수술 전 예 측인자 이외에도, 최종 모델은 7개의 수술 중 예측인자를 포 함한다(기관 삽관 후 이른 산소포화도 저하, 수술 장기화, 높은 흡입산소농도, 높은 혈압상승제 투여량, 수혈, 휘발성 마취제 미사용, 폐보호환기의 부재). 새롭게 계산한 점수의 receiver operating characteristic 곡선 아래 면적은 기존 SPORC 점 수보다 더 큰 것으로 나타났다(0.84 [95% 신뢰구간 0.82–0.85] vs. 0.76 [95% 신뢰구간 0.75–0.78], 각각 p ‹ 0.001). 이는 임 상의가 수술 후 조기 기관 재삽관의 위험감소 전략을 개발하 고 이행할 수 있도록 한다.