Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Klimawandel und Gesundheit Neues aus dem Markt COVID-19 Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende
Erweiterte Suche
Anmelden
nach oben
Surgery Today
Erschienen in: Surgery Today 9/2019

27.03.2019 | Original Article

Development and validation of a nomogram predicting postoperative pneumonia after major abdominal surgery

verfasst von: Keishi Kawasaki, Mariko Yamamoto, Yusuke Suka, Yohei Kawasaki, Kyoji Ito, Daisuke Koike, Takatoshi Furuya, Motoki Nagai, Yukihiro Nomura, Nobutaka Tanaka, Yoshikuni Kawaguchi

Erschienen in: Surgery Today | Ausgabe 9/2019

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Postoperative pneumonia (POP) is a common complication that can adversely affect the outcomes after surgery. This study aimed to devise and validate a model for stratifying the probability of POP in patients undergoing abdominal surgery.

Methods

We included 1050 patients who underwent major abdominal surgery between 2012 and 2013. A nomogram was devised by evaluating the predictive factors for POP.

Results

Of the 1050 patients, 56 (5.3%) developed POP. Multivariable logistic regression analysis revealed that the independent predictive factors for POP were age, male sex, history of cerebrovascular disease, Brinkman Index (BI) ≥ 900, and upper midline incision. A nomogram was devised by employing these five significant predictive factors. The prediction model showed a relatively good discrimination performance, with a concordance index of 0.77.

Conclusions

A nomogram based on age, male sex, history of cerebrovascular disease, BI ≥ 900, and upper midline incision may be useful for identifying patients with a high probability of developing POP after major abdominal surgery.
Literatur
1.
Arozullah AM, Khuri SF, Henderson WG, Daley J. Development and validation of a multifactorial risk index for predicting postoperative pneumonia after major noncardiac surgery. Ann Int Med. 2001;135:847–57.CrossRefPubMed
2.
Society AT. Infectious diseases society of America: guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171:388–416.CrossRef
3.
Rello J, Diaz E. Pneumonia in the intensive care unit. Criti Care Med. 2003;31:2544–51.CrossRef
4.
Kozlow JH, Berenholtz SM, Garrett E, Dorman T, Pronovost PJ. Epidemiology and impact of aspiration pneumonia in patients undergoing surgery in Maryland, 1999–2000. Crit Care Med 2003;31:1930–1937.CrossRefPubMed
5.
Mitchell CK, Smoger SH, Pfeifer MP, Vogel RL, Pandit MK, Donnelly PJ, et al. Multivariate analysis of factors associated with postoperative pulmonary complications following general elective surgery. Arch Surg. 1998;133:194–8.CrossRefPubMed
6.
Evaristo-Méndez G, Rocha-Calderón CH. Risk factors for nosocomial pneumonia in patients with abdominal surgery. Cirugía y Cirujanos (English Edition). 2016;84:21–7.CrossRef
7.
Studer P, Räber G, Ott D, Candinas D, Schnüriger B. Risk factors for fatal outcome in surgical patients with postoperative aspiration pneumonia. Int J Surg. 2016;27:21–5.CrossRefPubMed
8.
Qaseem A, Snow V, Fitterman N, Hornbake ER, Lawrence VA, Smetana GW, et al. Risk assessment for and strategies to reduce perioperative pulmonary complications for patients undergoing noncardiothoracic surgery: a guideline from the american college of physiciansreducing perioperative pulmonary complications in noncardiothoracic surgery. Ann Int Med. 2006;144:575–80.CrossRefPubMed
9.
Smetana GW, Lawrence VA, Cornell JE. Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American college of physicianspreoperative pulmonary risk stratification for noncardiothoracic surgery. Ann Int Med. 2006;144:581–95.CrossRefPubMed
10.
Lawrence VA, Cornell JE, Smetana GW. Strategies to reduce postoperative pulmonary complications after noncardiothoracic surgery: systematic review for the American college of physiciansstrategies to reduce postoperative pulmonary complications after noncardiothoracic surgery. Ann Int Med. 2006;144:596–608.CrossRefPubMed
11.
Thompson DA, Makary MA, Dorman T, Pronovost PJ. Clinical and economic outcomes of hospital acquired pneumonia in intra-abdominal surgery patients. Ann Surg. 2006;243:547.CrossRefPubMedPubMedCentral
12.
Kanat F, Golcuk A, Teke T, Golcuk M. Risk factors for postoperative pulmonary complications in upper abdominal surgery. ANZ J Surg. 2007;77:135–41.CrossRefPubMed
13.
Martin LF, Asher EF, Casey JM, Fry DE. Postoperative pneumonia: determinants of mortality. Arch Surg. 1984;119:379–83.CrossRefPubMed
14.
Nelson R, Edwards S, Tse B. Prophylactic nasogastric decompression after abdominal surgery. Cochrane Database Syst Rev 2004;3.
15.
Serejo LGG, da Silva-Júnior FP, Bastos JPC, de Bruin GS, Mota RMS, de Bruin PFC. Risk factors for pulmonary complications after emergency abdominal surgery. Respiratory Med. 2007;101:808–13.CrossRef
16.
Chughtai M, Gwam CU, Mohamed N, Khlopas A, Newman JM, Khan R, et al. The epidemiology and risk factors for postoperative pneumonia. J Clin Med Res. 2017;9:466.CrossRefPubMedPubMedCentral
17.
Martin-Loeches I, Torres A. Are preoperative oral care bundles needed to prevent postoperative pneumonia? Springer, Berlin, 2014.
18.
Akutsu Y, Matsubara H, Shuto K, Shiratori T, Uesato M, Miyazawa Y, et al. Pre-operative dental brushing can reduce the risk of postoperative pneumonia in esophageal cancer patients. Surgery. 2010;147:497–502.CrossRefPubMed
19.
Guimarães M, El Dib R, Smith AF, Matos D. Incentive spirometry for prevention of postoperative pulmonary complications in upper abdominal surgery. Cochrane Database Syst Rev 2009;3.
20.
Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: a review. JAMA Surg. 2017;152:292–8.CrossRefPubMed
21.
Wren SM, Martin M, Yoon JK, Bech F. Postoperative pneumonia-prevention program for the inpatient surgical ward. J Am Coll Surg. 2010;210:491–5.CrossRefPubMed
22.
Gustafsson U, Scott M, Schwenk W, Demartines N, Roulin D, Francis N, et al. Guidelines for perioperative care in elective colonic surgery: enhanced recovery after surgery (ERAS®) society recommendations. Clin Nutr. 2012;31:783–800.CrossRefPubMed
23.
Yamada T, Hayashi T, Cho H, Yoshikawa T, Taniguchi H, Fukushima R, et al. Usefulness of enhanced recovery after surgery protocol as compared with conventional perioperative care in gastric surgery. Gastric Cancer. 2012;15:34–41.CrossRefPubMed
24.
Jones C, Kelliher L, Dickinson M, Riga A, Worthington T, Scott M, et al. Randomized clinical trial on enhanced recovery versus standard care following open liver resection. Br J Surg. 2013;100:1015–24.CrossRefPubMed
25.
Gotlib Conn L, Rotstein OD, Greco E, Tricco AC, Perrier L, Soobiah C, et al. Enhanced recovery after vascular surgery: protocol for a systematic review. Syst Rev. 2012;1:52.CrossRefPubMedPubMedCentral
26.
Lassen K, Coolsen MM, Slim K, Carli F, de Aguilar-Nascimento JE, Schafer M, et al. Guidelines for perioperative care for pancreaticoduodenectomy: enhanced recovery after surgery (ERAS(R)) society recommendations. Clin Nutr. 2012;31:817–30.CrossRefPubMed
27.
Dindo D, Demartines N, Clavien P-A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205.CrossRefPubMedPubMedCentral
28.
Chapuis PH, Bokey L, Keshava A, Rickard MJ, Stewart P, Young CJ, et al. Risk factors for prolonged ileus after resection of colorectal cancer: an observational study of 2400 consecutive patients. Ann Surg. 2013;257:909–15.CrossRefPubMed
29.
Moons KG, Altman DG, Reitsma JB, Ioannidis JP, Macaskill P, Steyerberg EW, et al. Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): explanation and elaboration. Ann Intern Med. 2015;162:W1–73.CrossRefPubMed
30.
Harrell FE Jr, Lee KL, Mark DB. Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med. 1996;15:361–87.CrossRefPubMed
31.
Efron B, Tibshirani R. An introduction to the bootstrap. New York: Chapman & Hall; 1993.CrossRef
32.
Efron B, Tibshirani R. Improvements on cross-validation: The.632 + bootstrap method. J Am Stat Association. 1997;92:548–60.
33.
Thompson DA, Makary MA, Dorman T, Pronovost PJ. Clinical and economic outcomes of hospital acquired pneumonia in intra-abdominal surgery patients. Ann Surg. 2006;243:547–52.CrossRefPubMedPubMedCentral
34.
Shander A, Fleisher LA, Barie PS, Bigatello LM, Sladen RN, Watson CB. Clinical and economic burden of postoperative pulmonary complications: patient safety summit on definition, risk-reducing interventions, and preventive strategies. Crit Care Med. 2011;39:2163–72.CrossRefPubMed
35.
Braga M, Gianotti L, Radaelli G, et al. Perioperative immunonutrition in patients undergoing cancer surgery: results of a randomized double-blind phase 3 trial. Arch Surg. 1999;134:428–33.CrossRefPubMed
36.
Giger U, Buchler M, Farhadi J, Berger D, Husler J, Schneider H, et al. Preoperative immunonutrition suppresses perioperative inflammatory response in patients with major abdominal surgery-a randomized controlled pilot study. Ann Surg Oncol. 2007;14:2798–806.CrossRefPubMed
37.
Smetana GW. Postoperative pulmonary complications: an update on risk assessment and reduction. Clevel Clin J Med. 2009;76:60.CrossRef
38.
Dureuil B, Cantineau J, Desmonts J. Effects of upper or lower abdominal surgery on diaphragmatic function. BJA. 1987;59:1230–5.CrossRefPubMed
39.
Ford G, Rosenal T, Clergue F, Whitelaw W. Respiratory physiology in upper abdominal surgery. Clin Chest Med. 1993;14:237–52.PubMed
Metadaten
Titel
Development and validation of a nomogram predicting postoperative pneumonia after major abdominal surgery
verfasst von
Keishi Kawasaki
Mariko Yamamoto
Yusuke Suka
Yohei Kawasaki
Kyoji Ito
Daisuke Koike
Takatoshi Furuya
Motoki Nagai
Yukihiro Nomura
Nobutaka Tanaka
Yoshikuni Kawaguchi
Publikationsdatum
27.03.2019
Verlag
Springer Singapore
Erschienen in
Surgery Today / Ausgabe 9/2019
Print ISSN: 0941-1291
Elektronische ISSN: 1436-2813
DOI
https://doi.org/10.1007/s00595-019-01796-8

Weitere Artikel der Ausgabe 9/2019

Surgery Today 9/2019 Zur Ausgabe

Review Article

The roles played by the MYCN, Trk, and ALK genes in neuroblastoma and neural development

Original Article

Prognostic predictions based on pathological findings of peritoneal dissemination in patients with stage IV colorectal cancer without residual disease (R0 status)

Original Article

A clinical trial of somatic and germline analyses for healthy longevity in a postoperative cancer patient

Original Article

Intraperitoneal chemotherapy for peritoneal metastases using sustained release formula of cisplatin-incorporated gelatin hydrogel granules

Review Article

Short-term outcomes of a self-expandable metallic stent as a bridge to surgery vs. a transanal decompression tube for malignant large-bowel obstruction: a meta-analysis

Original Article

Surgical outcome of pulmonary artery reconstruction using the expanded polytetrafluoroethylene patch in patients with lung cancer

Neu im Fachgebiet Chirurgie

23.04.2024 | Ablationstherapie | Nachrichten

Wie erfolgreich ist eine Re-Ablation nach Rezidiv?

23.04.2024 | Appendizitis | Nachrichten

Hinter dieser Appendizitis steckte ein Erreger

23.04.2024 | Operationsvorbereitung | Nachrichten

Mehr Schaden als Nutzen durch präoperatives Aussetzen von GLP-1-Agonisten?

19.04.2024 | EAU 2024 | Kongressbericht | Nachrichten

Ureterstriktur: Innovative OP-Technik bewährt sich
weitere anzeigen

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.