Journal article
Existing Predictive Models for Postoperative Pulmonary Complications Perform Poorly in a Head and Neck Surgery Population
Journal of medical systems, Vol.43(10), pp.312-7
10/01/2019
DOI: 10.1007/s10916-019-1435-x
PMCID: PMC6800103
PMID: 31451999
Abstract
Postoperative pulmonary complications (PPCs) are common following major surgical procedures. Risk stratification tools have been developed to identify patients at risk for PPCs. While otolaryngology cases were included in the development of common predictive tools, they comprised small percentages in each tool. It is unclear how these tools perform in patients undergoing major head and neck surgery with free flap reconstruction. This retrospective review studied all free flap reconstructions in head and neck surgery over a 12-year period at a single institution in the southeastern US. Baseline demographic and medical information were included for each case. All cases were reviewed for development of major PPCs, including pneumonia and respiratory failure. The cohort underwent risk stratification using the ARISCAT and Gupta pulmonary risk indices. Performance of these predictive models for head and neck surgery was determined through receiver-operator curve comparison. 794 patients were identified with a median age of 62 years (IQR 41-83). Sixty-five percent were male. Forty-three (5.4%) developed pneumonia, 23 patients developed respiratory failure (2.9%), and 38 patients developed both (4.8%), resulting in a total PPC proportion of 13.1% (n = 104). Both ARISCAT and Gupta pulmonary risk indices demonstrated low discrimination to predict PPCs in head and neck free flap reconstruction, with areas under the curve of 0.60 and 0.65, respectively. Two major indices for prediction of postoperative pulmonary complications do not accurately identify risk in patients undergoing major head and neck surgery. Further studies are needed to develop predictive tools for PPCs in this high-risk population.
Details
- Title: Subtitle
- Existing Predictive Models for Postoperative Pulmonary Complications Perform Poorly in a Head and Neck Surgery Population
- Creators
- C. Burton Wood - Vanderbilt University Medical CenterJustin R. Shinn - Vanderbilt University Medical CenterAndrew B. Rees - Vanderbilt UniversityPriyesh N. Patel - Vanderbilt University Medical CenterRobert E. Freundlich - Vanderbilt University Medical CenterDerek K. Smith - Vanderbilt University Medical CenterMatthew D. McEvoy - Vanderbilt University Medical CenterSarah L. Rohde - Vanderbilt University Medical Center
- Resource Type
- Journal article
- Publication Details
- Journal of medical systems, Vol.43(10), pp.312-7
- DOI
- 10.1007/s10916-019-1435-x
- PMID
- 31451999
- PMCID
- PMC6800103
- NLM abbreviation
- J Med Syst
- ISSN
- 0148-5598
- eISSN
- 1573-689X
- Publisher
- Springer Nature
- Number of pages
- 7
- Grant note
- KL2 TR002245 / NCATS NIH HHS; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Center for Advancing Translational Sciences (NCATS) KL2TR002245 / NATIONAL CENTER FOR ADVANCING TRANSLATIONAL SCIENCES; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Center for Advancing Translational Sciences (NCATS)
- Language
- English
- Date published
- 10/01/2019
- Academic Unit
- Preventive and Community Dentistry; Dental Research
- Record Identifier
- 9984966755602771
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