PURPOSE: Preoperative risk stratification focuses on cardiac risk, little is known about the broad implications of respiratory comorbidities and post-operative occurrences in the diverse population of surgical patients. We hypothesized that patients with preoperative respiratory co-morbidities would be at increased risk of postoperative respiratory occurrences and death.
METHODS: Under the data use agreement and with the approval of our IRB, we reviewed five years (2005-2009) of NSQIP Public Use Files. Respiratory co-morbidities (RCM) were: Current smoker, COPD, Dyspnea, Current Pneumonia. Respiratory outcomes tracked in NSQIP included: Reintubation, Post-operative pneumonia, and prolonged ventilation. We defined Clavien 4 and 5 outcomes to include: postoperative septic shock, postoperative dialysis, pulmonary embolism, MI, cardiac arrest, prolonged ventilatory requirements, need for reintubation and death. Data reported here was significant at p< .001.
RESULTS: Of 971,455 patients evaluated, 361,412 had RCM. Results are summarized in Table 1. As the number of RCM increased there was statistically significant increase in occurrence of postoperative respiratory adverse events including Clavien 4 and 5 complications. By multivariate regression analysis we find ASA class, pre operative functional health status, wound classification, and RCM were independent predictors of mortality. All data reported here significant at P<0.001.
CONCLUSIONS: In our review we do find a significant association with RCM and postoperative adverse events including clavien 4 complications and death. Further prospective studies are required to explore this association.
CLINICAL IMPLICATIONS: The clinical implication is to develop a respiratory risk stratification for patient's in the preoperative period.
DISCLOSURE: The following authors have nothing to disclose: Arielle Hodari, Subhash Reddy, Michael Eichenhorn, Ilan Rubinfeld, Mathilda Horst
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