Multifactorial risk index for predicting postoperative respiratory failure in men after major noncardiac surgery. The National Veterans Administration Surgical Quality Improvement Program

Ann Surg. 2000 Aug;232(2):242-53. doi: 10.1097/00000658-200008000-00015.


Objective: To develop and validate a preoperative risk index for predicting postoperative respiratory failure (PRF).

Summary background data: Respiratory failure is an important postoperative complication.

Method: Based on a prospective cohort study, cases from 44 Veterans Affairs Medical Centers (n = 81,719) were used to develop the models. Cases from 132 Veterans Affairs Medical Centers (n = 99,390) were used as a validation sample. PRF was defined as mechanical ventilation for more than 48 hours after surgery or reintubation and mechanical ventilation after postoperative extubation. Ventilator-dependent, comatose, do not resuscitate, and female patients were excluded.

Results: PRF developed in 2,746 patients (3.4%). The respiratory failure risk index was developed from a simplified logistic regression model and included abdominal aortic aneurysm repair, thoracic surgery, neurosurgery, upper abdominal surgery, peripheral vascular surgery, neck surgery, emergency surgery, albumin level less than 30 g/L, blood urea nitrogen level more than 30 mg/dL, dependent functional status, chronic obstructive pulmonary disease, and age.

Conclusions: The respiratory failure risk index is a validated model for identifying patients at risk for developing PRF and may be useful for guiding perioperative respiratory care.

Publication types

  • Multicenter Study
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Aged
  • Cohort Studies
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Models, Statistical*
  • Multivariate Analysis
  • Postoperative Complications / epidemiology*
  • Respiratory Insufficiency / epidemiology*
  • Risk
  • Risk Factors