Predicting risk of postoperative lung injury in high-risk surgical patients

A multicenter cohort study

Daryl J. Kor, Ravi K. Lingineni, Ognjen Gajic, Pauline K. Park, James M. Blum, Peter C. Hou, J. Jason Hoth, Harry L. Anderson, Ednan K. Bajwa, Raquel R. Bartz, Adebola Adesanya, Emir Festic, Michelle Ng Gong, Rickey E. Carter, Daniel S. Talmor

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

BACKGROUND:: Acute respiratory distress syndrome (ARDS) remains a serious postoperative complication. Although ARDS prevention is a priority, the inability to identify patients at risk for ARDS remains a barrier to progress. The authors tested and refined the previously reported surgical lung injury prediction (SLIP) model in a multicenter cohort of at-risk surgical patients. METHODS:: This is a secondary analysis of a multicenter, prospective cohort investigation evaluating high-risk patients undergoing surgery. Preoperative ARDS risk factors and risk modifiers were evaluated for inclusion in a parsimonious risk-prediction model. Multiple imputation and domain analysis were used to facilitate development of a refined model, designated SLIP-2. Area under the receiver operating characteristic curve and the Hosmer-Lemeshow goodness-of-fit test were used to assess model performance. RESULTS:: Among 1,562 at-risk patients, ARDS developed in 117 (7.5%). Nine independent predictors of ARDS were identified: sepsis, high-risk aortic vascular surgery, high-risk cardiac surgery, emergency surgery, cirrhosis, admission location other than home, increased respiratory rate (20 to 29 and β‰130 breaths/min), FIO2 greater than 35%, and SpO2 less than 95%. The original SLIP score performed poorly in this heterogeneous cohort with baseline risk factors for ARDS (area under the receiver operating characteristic curve [95% CI], 0.56 [0.50 to 0.62]). In contrast, SLIP-2 score performed well (area under the receiver operating characteristic curve [95% CI], 0.84 [0.81 to 0.88]). Internal validation indicated similar discrimination, with an area under the receiver operating characteristic curve of 0.84. CONCLUSIONS:: In this multicenter cohort of patients at risk for ARDS, the SLIP-2 score outperformed the original SLIP score. If validated in an independent sample, this tool may help identify surgical patients at high risk for ARDS.

Original languageEnglish (US)
Pages (from-to)1168-1181
Number of pages14
JournalAnesthesiology
Volume120
Issue number5
DOIs
StatePublished - 2014

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Lung Injury
Adult Respiratory Distress Syndrome
Multicenter Studies
Cohort Studies
Intraoperative Complications
ROC Curve
Respiratory Rate
Thoracic Surgery
Blood Vessels
Sepsis
Emergencies
Fibrosis

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Kor, D. J., Lingineni, R. K., Gajic, O., Park, P. K., Blum, J. M., Hou, P. C., ... Talmor, D. S. (2014). Predicting risk of postoperative lung injury in high-risk surgical patients: A multicenter cohort study. Anesthesiology, 120(5), 1168-1181. https://doi.org/10.1097/ALN.0000000000000216

Predicting risk of postoperative lung injury in high-risk surgical patients : A multicenter cohort study. / Kor, Daryl J.; Lingineni, Ravi K.; Gajic, Ognjen; Park, Pauline K.; Blum, James M.; Hou, Peter C.; Hoth, J. Jason; Anderson, Harry L.; Bajwa, Ednan K.; Bartz, Raquel R.; Adesanya, Adebola; Festic, Emir; Gong, Michelle Ng; Carter, Rickey E.; Talmor, Daniel S.

In: Anesthesiology, Vol. 120, No. 5, 2014, p. 1168-1181.

Research output: Contribution to journalArticle

Kor, DJ, Lingineni, RK, Gajic, O, Park, PK, Blum, JM, Hou, PC, Hoth, JJ, Anderson, HL, Bajwa, EK, Bartz, RR, Adesanya, A, Festic, E, Gong, MN, Carter, RE & Talmor, DS 2014, 'Predicting risk of postoperative lung injury in high-risk surgical patients: A multicenter cohort study', Anesthesiology, vol. 120, no. 5, pp. 1168-1181. https://doi.org/10.1097/ALN.0000000000000216
Kor, Daryl J. ; Lingineni, Ravi K. ; Gajic, Ognjen ; Park, Pauline K. ; Blum, James M. ; Hou, Peter C. ; Hoth, J. Jason ; Anderson, Harry L. ; Bajwa, Ednan K. ; Bartz, Raquel R. ; Adesanya, Adebola ; Festic, Emir ; Gong, Michelle Ng ; Carter, Rickey E. ; Talmor, Daniel S. / Predicting risk of postoperative lung injury in high-risk surgical patients : A multicenter cohort study. In: Anesthesiology. 2014 ; Vol. 120, No. 5. pp. 1168-1181.
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abstract = "BACKGROUND:: Acute respiratory distress syndrome (ARDS) remains a serious postoperative complication. Although ARDS prevention is a priority, the inability to identify patients at risk for ARDS remains a barrier to progress. The authors tested and refined the previously reported surgical lung injury prediction (SLIP) model in a multicenter cohort of at-risk surgical patients. METHODS:: This is a secondary analysis of a multicenter, prospective cohort investigation evaluating high-risk patients undergoing surgery. Preoperative ARDS risk factors and risk modifiers were evaluated for inclusion in a parsimonious risk-prediction model. Multiple imputation and domain analysis were used to facilitate development of a refined model, designated SLIP-2. Area under the receiver operating characteristic curve and the Hosmer-Lemeshow goodness-of-fit test were used to assess model performance. RESULTS:: Among 1,562 at-risk patients, ARDS developed in 117 (7.5{\%}). Nine independent predictors of ARDS were identified: sepsis, high-risk aortic vascular surgery, high-risk cardiac surgery, emergency surgery, cirrhosis, admission location other than home, increased respiratory rate (20 to 29 and β‰130 breaths/min), FIO2 greater than 35{\%}, and SpO2 less than 95{\%}. The original SLIP score performed poorly in this heterogeneous cohort with baseline risk factors for ARDS (area under the receiver operating characteristic curve [95{\%} CI], 0.56 [0.50 to 0.62]). In contrast, SLIP-2 score performed well (area under the receiver operating characteristic curve [95{\%} CI], 0.84 [0.81 to 0.88]). Internal validation indicated similar discrimination, with an area under the receiver operating characteristic curve of 0.84. CONCLUSIONS:: In this multicenter cohort of patients at risk for ARDS, the SLIP-2 score outperformed the original SLIP score. If validated in an independent sample, this tool may help identify surgical patients at high risk for ARDS.",
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T1 - Predicting risk of postoperative lung injury in high-risk surgical patients

T2 - A multicenter cohort study

AU - Kor, Daryl J.

AU - Lingineni, Ravi K.

AU - Gajic, Ognjen

AU - Park, Pauline K.

AU - Blum, James M.

AU - Hou, Peter C.

AU - Hoth, J. Jason

AU - Anderson, Harry L.

AU - Bajwa, Ednan K.

AU - Bartz, Raquel R.

AU - Adesanya, Adebola

AU - Festic, Emir

AU - Gong, Michelle Ng

AU - Carter, Rickey E.

AU - Talmor, Daniel S.

PY - 2014

Y1 - 2014

N2 - BACKGROUND:: Acute respiratory distress syndrome (ARDS) remains a serious postoperative complication. Although ARDS prevention is a priority, the inability to identify patients at risk for ARDS remains a barrier to progress. The authors tested and refined the previously reported surgical lung injury prediction (SLIP) model in a multicenter cohort of at-risk surgical patients. METHODS:: This is a secondary analysis of a multicenter, prospective cohort investigation evaluating high-risk patients undergoing surgery. Preoperative ARDS risk factors and risk modifiers were evaluated for inclusion in a parsimonious risk-prediction model. Multiple imputation and domain analysis were used to facilitate development of a refined model, designated SLIP-2. Area under the receiver operating characteristic curve and the Hosmer-Lemeshow goodness-of-fit test were used to assess model performance. RESULTS:: Among 1,562 at-risk patients, ARDS developed in 117 (7.5%). Nine independent predictors of ARDS were identified: sepsis, high-risk aortic vascular surgery, high-risk cardiac surgery, emergency surgery, cirrhosis, admission location other than home, increased respiratory rate (20 to 29 and β‰130 breaths/min), FIO2 greater than 35%, and SpO2 less than 95%. The original SLIP score performed poorly in this heterogeneous cohort with baseline risk factors for ARDS (area under the receiver operating characteristic curve [95% CI], 0.56 [0.50 to 0.62]). In contrast, SLIP-2 score performed well (area under the receiver operating characteristic curve [95% CI], 0.84 [0.81 to 0.88]). Internal validation indicated similar discrimination, with an area under the receiver operating characteristic curve of 0.84. CONCLUSIONS:: In this multicenter cohort of patients at risk for ARDS, the SLIP-2 score outperformed the original SLIP score. If validated in an independent sample, this tool may help identify surgical patients at high risk for ARDS.

AB - BACKGROUND:: Acute respiratory distress syndrome (ARDS) remains a serious postoperative complication. Although ARDS prevention is a priority, the inability to identify patients at risk for ARDS remains a barrier to progress. The authors tested and refined the previously reported surgical lung injury prediction (SLIP) model in a multicenter cohort of at-risk surgical patients. METHODS:: This is a secondary analysis of a multicenter, prospective cohort investigation evaluating high-risk patients undergoing surgery. Preoperative ARDS risk factors and risk modifiers were evaluated for inclusion in a parsimonious risk-prediction model. Multiple imputation and domain analysis were used to facilitate development of a refined model, designated SLIP-2. Area under the receiver operating characteristic curve and the Hosmer-Lemeshow goodness-of-fit test were used to assess model performance. RESULTS:: Among 1,562 at-risk patients, ARDS developed in 117 (7.5%). Nine independent predictors of ARDS were identified: sepsis, high-risk aortic vascular surgery, high-risk cardiac surgery, emergency surgery, cirrhosis, admission location other than home, increased respiratory rate (20 to 29 and β‰130 breaths/min), FIO2 greater than 35%, and SpO2 less than 95%. The original SLIP score performed poorly in this heterogeneous cohort with baseline risk factors for ARDS (area under the receiver operating characteristic curve [95% CI], 0.56 [0.50 to 0.62]). In contrast, SLIP-2 score performed well (area under the receiver operating characteristic curve [95% CI], 0.84 [0.81 to 0.88]). Internal validation indicated similar discrimination, with an area under the receiver operating characteristic curve of 0.84. CONCLUSIONS:: In this multicenter cohort of patients at risk for ARDS, the SLIP-2 score outperformed the original SLIP score. If validated in an independent sample, this tool may help identify surgical patients at high risk for ARDS.

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