Advertisement

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

  • Keishi Kawasaki
  • Mariko Yamamoto
  • Yusuke Suka
  • Yohei Kawasaki
  • Kyoji Ito
  • Daisuke Koike
  • Takatoshi Furuya
  • Motoki Nagai
  • Yukihiro Nomura
  • Nobutaka TanakaEmail author
  • Yoshikuni KawaguchiEmail author
Original Article
  • 36 Downloads

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.

Keywords

Postoperative pneumonia Major abdominal surgery Upper midline incision Predictive factor 

Abbreviations

POP

Postoperative pneumonia

BI

Brinkman Index

ICU

Intensive care unit

POD

Postoperative day

PS

Performance status

CI

Cerebral infarction

ASA

The American society of anesthesiologists physical status classification system

PNI

Prognostic nutritional index

IQR

Interquartile ranges

ORs

Odds ratios

CIs

Confidence intervals

BMI

Body mass index

Notes

Funding

None.

Compliance with ethical standards

Conflict of interest

The authors declare no conflicts of interest in association with the present study.

References

  1. 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.CrossRefGoogle Scholar
  2. 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.CrossRefGoogle Scholar
  3. 3.
    Rello J, Diaz E. Pneumonia in the intensive care unit. Criti Care Med. 2003;31:2544–51.CrossRefGoogle Scholar
  4. 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.CrossRefGoogle Scholar
  5. 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.CrossRefGoogle Scholar
  6. 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.CrossRefGoogle Scholar
  7. 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.CrossRefGoogle Scholar
  8. 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.CrossRefGoogle Scholar
  9. 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.CrossRefGoogle Scholar
  10. 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.CrossRefGoogle Scholar
  11. 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.CrossRefGoogle Scholar
  12. 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.CrossRefGoogle Scholar
  13. 13.
    Martin LF, Asher EF, Casey JM, Fry DE. Postoperative pneumonia: determinants of mortality. Arch Surg. 1984;119:379–83.CrossRefGoogle Scholar
  14. 14.
    Nelson R, Edwards S, Tse B. Prophylactic nasogastric decompression after abdominal surgery. Cochrane Database Syst Rev 2004;3.Google Scholar
  15. 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.CrossRefGoogle Scholar
  16. 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.CrossRefGoogle Scholar
  17. 17.
    Martin-Loeches I, Torres A. Are preoperative oral care bundles needed to prevent postoperative pneumonia? Springer, Berlin, 2014.Google Scholar
  18. 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.CrossRefGoogle Scholar
  19. 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.Google Scholar
  20. 20.
    Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: a review. JAMA Surg. 2017;152:292–8.CrossRefGoogle Scholar
  21. 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.CrossRefGoogle Scholar
  22. 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.CrossRefGoogle Scholar
  23. 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.CrossRefGoogle Scholar
  24. 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.CrossRefGoogle Scholar
  25. 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.CrossRefGoogle Scholar
  26. 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.CrossRefGoogle Scholar
  27. 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.CrossRefGoogle Scholar
  28. 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.CrossRefGoogle Scholar
  29. 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.CrossRefGoogle Scholar
  30. 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.CrossRefGoogle Scholar
  31. 31.
    Efron B, Tibshirani R. An introduction to the bootstrap. New York: Chapman & Hall; 1993.CrossRefGoogle Scholar
  32. 32.
    Efron B, Tibshirani R. Improvements on cross-validation: The.632 + bootstrap method. J Am Stat Association. 1997;92:548–60.Google Scholar
  33. 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.CrossRefGoogle Scholar
  34. 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.CrossRefGoogle Scholar
  35. 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.CrossRefGoogle Scholar
  36. 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.CrossRefGoogle Scholar
  37. 37.
    Smetana GW. Postoperative pulmonary complications: an update on risk assessment and reduction. Clevel Clin J Med. 2009;76:60.CrossRefGoogle Scholar
  38. 38.
    Dureuil B, Cantineau J, Desmonts J. Effects of upper or lower abdominal surgery on diaphragmatic function. BJA. 1987;59:1230–5.CrossRefGoogle Scholar
  39. 39.
    Ford G, Rosenal T, Clergue F, Whitelaw W. Respiratory physiology in upper abdominal surgery. Clin Chest Med. 1993;14:237–52.Google Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Keishi Kawasaki
    • 1
    • 2
  • Mariko Yamamoto
    • 1
  • Yusuke Suka
    • 1
  • Yohei Kawasaki
    • 3
  • Kyoji Ito
    • 1
    • 4
  • Daisuke Koike
    • 1
  • Takatoshi Furuya
    • 1
  • Motoki Nagai
    • 1
  • Yukihiro Nomura
    • 1
  • Nobutaka Tanaka
    • 1
    Email author
  • Yoshikuni Kawaguchi
    • 1
    • 4
    Email author
  1. 1.Department of SurgeryAsahi General HospitalChibaJapan
  2. 2.Department of General Surgery, Graduate School of MedicineChiba UniversityChibaJapan
  3. 3.Biostatistics Section, Clinical Research CenterChiba University HospitalChibaJapan
  4. 4.Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of MedicineThe University of TokyoTokyoJapan

Personalised recommendations