Development and validation of a score to predict postoperative respiratory failure in a multicentre European cohort: A prospective, observational study

Eur J Anaesthesiol. 2015 Jul;32(7):458-70. doi: 10.1097/EJA.0000000000000223.


Background: Postoperative respiratory failure (PRF) is the most frequent respiratory complication following surgery.

Objective: The objective of this study was to build a clinically useful predictive model for the development of PRF.

Design: A prospective observational study of a multicentre cohort.

Setting: Sixty-three hospitals across Europe.

Patients: Patients undergoing any surgical procedure under general or regional anaesthesia during 7-day recruitment periods.

Main outcome measures: Development of PRF within 5 days of surgery. PRF was defined by a partial pressure of oxygen in arterial blood (PaO2) less than 8 kPa or new onset oxyhaemoglobin saturation measured by pulse oximetry (SpO2) less than 90% whilst breathing room air that required conventional oxygen therapy, noninvasive or invasive mechanical ventilation.

Results: PRF developed in 224 patients (4.2% of the 5384 patients studied). In-hospital mortality [95% confidence interval (95% CI)] was higher in patients who developed PRF [10.3% (6.3 to 14.3) vs. 0.4% (0.2 to 0.6)]. Regression modelling identified a predictive PRF score that includes seven independent risk factors: low preoperative SpO2; at least one preoperative respiratory symptom; preoperative chronic liver disease; history of congestive heart failure; open intrathoracic or upper abdominal surgery; surgical procedure lasting at least 2 h; and emergency surgery. The area under the receiver operating characteristic curve (c-statistic) was 0.82 (95% CI 0.79 to 0.85) and the Hosmer-Lemeshow goodness-of-fit statistic was 7.08 (P = 0.253).

Conclusion: A risk score based on seven objective, easily assessed factors was able to predict which patients would develop PRF. The score could potentially facilitate preoperative risk assessment and management and provide a basis for testing interventions to improve outcomes.The study was registered at (identifier NCT01346709).

Publication types

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

MeSH terms

  • Adult
  • Aged
  • Anesthesia, Conduction
  • Anesthesia, General
  • Cohort Studies
  • Critical Care / statistics & numerical data
  • Europe
  • Female
  • Hospital Mortality
  • Humans
  • Male
  • Middle Aged
  • Oximetry
  • Oxygen / blood
  • Oxyhemoglobins / analysis
  • Oxyhemoglobins / metabolism
  • Postoperative Complications / diagnosis*
  • Postoperative Complications / mortality
  • Postoperative Complications / prevention & control*
  • Prospective Studies
  • Respiratory Insufficiency / diagnosis*
  • Respiratory Insufficiency / mortality
  • Respiratory Insufficiency / prevention & control*
  • Risk Factors
  • Treatment Outcome


  • Oxyhemoglobins
  • Oxygen

Associated data