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Development of a prediction model for postoperative pneumonia

A multicentre prospective observational study

Russotto, Vincenzo; Sabaté, Sergi; Canet, Jaume for the PERISCOPE group of the European Society of Anaesthesiology (ESA) Clinical Trial Network

European Journal of Anaesthesiology (EJA): February 2019 - Volume 36 - Issue 2 - p 93–104
doi: 10.1097/EJA.0000000000000921
Perioperative medicine
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BACKGROUND Postoperative pneumonia is associated with increased morbidity, mortality and costs. Prediction models of pneumonia that are currently available are based on retrospectively collected data and administrative coding systems.

OBJECTIVE To identify independent variables associated with the occurrence of postoperative pneumonia.

DESIGN A prospective observational study of a multicentre cohort (Prospective Evaluation of a RIsk Score for postoperative pulmonary COmPlications in Europe database).

SETTING Sixty-three hospitals in Europe.

PATIENTS Patients undergoing surgery under general and/or regional anaesthesia during a 7-day recruitment period.

MAIN OUTCOME MEASURE The primary outcome was postoperative pneumonia. Definition: the need for treatment with antibiotics for a respiratory infection and at least one of the following criteria: new or changed sputum; new or changed lung opacities on a clinically indicated chest radiograph; temperature more than 38.3 °C; leucocyte count more than 12 000 μl−1.

RESULTS Postoperative pneumonia occurred in 120 out of 5094 patients (2.4%). Eighty-two of the 120 (68.3%) patients with pneumonia required ICU admission, compared with 399 of the 4974 (8.0%) without pneumonia (P < 0.001). We identified five variables independently associated with postoperative pneumonia: functional status [odds ratio (OR) 2.28, 95% confidence interval (CI) 1.58 to 3.12], pre-operative SpO2 values while breathing room air (OR 0.83, 95% CI 0.78 to 0.84), intra-operative colloid administration (OR 2.97, 95% CI 1.94 to 3.99), intra-operative blood transfusion (OR 2.19, 95% CI 1.41 to 4.71) and surgical site (open upper abdominal surgery OR 3.98, 95% CI 2.19 to 7.59). The model had good discrimination (c-statistic 0.89) and calibration (Hosmer–Lemeshow P = 0.572).

CONCLUSION We identified five variables independently associated with postoperative pneumonia. The model performed well and after external validation may be used for risk stratification and management of patients at risk of postoperative pneumonia.

TRIAL REGISTRATION NCT 01346709 (ClinicalTrials.gov).

From the Department of Emergency and Intensive Care, ASST Monza, University Hospital San Gerardo, Monza, Italy (VR), Department of Anaesthesiology, Fundació Puigvert (IUNA) (SS) and Department of Anaesthesiology and Critical Care, Hospital Germans Trias i Pujol, Barcelona, Spain (JC)

Correspondence to Vincenzo Russotto, Department of Emergency and Intensive Care, ASST Monza, University Hospital San Gerardo, Via G. B. Pergolesi, 33, 20900 Monza, Italy Tel: +39 0392339269; e-mail: vinrussotto@gmail.com

Published online 13 November 2018

© 2019 European Society of Anaesthesiology