gupta indices for postop pulmonary complications
DESCRIPTION
Gupta and colleagues developed 2 prediction rules that can be used to estimate a patient's risk for postoperative pneumonia or respiratory failure. I also review an older prediction rule and show how it compares to the Gupta rules.TRANSCRIPT
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NSQIP (Gupta) Indices for Predicting Postoperative Pneumonia and Respiratory
Failure
Terry Shaneyfelt, MD, MPHAssociate Professor, UAB Department of Medicine
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Predicting Postoperative Pulmonary Risk
• Pulmonary function testing has limited predictive value
• 2 recently developed prediction tools• National Surgery Quality Improvement Program Risk
Calculator (NSQIP) AKA Gupta Criteria• Respiratory failure• Pneumonia
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What factors are predictive of risk in these indices?
CHEST 2011;140:1207
Mayo Clin Proc 2013;88:1241
POSTOP RESPIRATORY FAILURE
• ASA class• Dependent functional status• Emergency procedure• Preoperative sepsis• Type of surgery
POSTOP PNEUMONIA• Age• ASA class• COPD• Dependent functional status• Preoperative sepsis• Smoking in past year• Type of surgery
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VASQIP (Arozullah) IndicesAnn Intern Med 2001;135:847 Ann Surgery 2000;232:242
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Gupta Arozullah
Methodology NSQIP databases, Prospective cohorts
VASQIP database,Prospective cohorts
Patient Population 468,795 patients in 183-211 community & academic hospitals
316,071 patients in 100 VA hospitals
Date of development 2007/2008 1995-1999
Outcomes Respiratory FailurePneumonia
Respiratory FailurePneumonia
C-statistic Resp Failure: 0.897Pneumonia: 0.855
Resp Failure: 0.834Pneumonia: 0.817
Notable limitations No OSA, asthma, h/o VTE, PFTsVeterans, almost no females, Surgeries classified on incision site and not organ involved
Comparison of the Gupta and Arozullah Indices
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• NSQIP (Gupta) indices have slightly better predictive performance, is more surgery specific, and more contemporary than the VASQIP (Arozullah) index
• Gupta is easier to use
Summary
Become familiar with one modeland use it regularly