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Development and Validation of a Multifactorial Risk Index for Predicting Postoperative Pneumonia after Major Noncardiac Surgery

Ahsan M. Arozullah, MD, MPH; Shukri F. Khuri, MD; William G. Henderson, PhD; Jennifer Daley, MD, Participants in the National Veterans Affairs Surgical Quality Improvement Program
[+] Article and Author Information

From Veterans Affairs Chicago Healthcare System, Westside Division, University of Illinois College of Medicine, Chicago, and Hines Veterans Affairs Cooperative Studies Program Coordinating Center, Hines, Illinois; Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts; and Harvard Medical School, Brigham and Women's Hospital, and Center for Health System Design and Evaluation/Institute for Health Policy, Massachusetts General Hospital/Partners Health Care System, Boston, Massachusetts.


Acknowledgments: The authors thank Kwan Hur, PhD, for assistance with statistical analysis.

Grant Support: The Office of Patient Care Services and the Health Services Research and Development Service of the Department of Veterans Affairs (grant SDR 91) funded The National VA Surgical Quality Improvement Program. Dr. Arozullah is a Research Associate in the Career Development Award Program of the Veterans Affairs Health Services Research and Development Service. Dr. Daley was a Senior Research Associate in the Career Development Award Program of the Veterans Affairs Health Services Research and Development Service at the time that this research was conducted.

Requests for Single Reprints: Ahsan M. Arozullah, MD, MPH, Section of General Internal Medicine (M/C 787), University of Illinois College of Medicine, 840 South Wood Street, Room 440-M, Chicago, IL 60612-7323; e-mail, arozulla@uic.edu.

Current Author Addresses: Dr. Arozullah: Section of General Internal Medicine (M/C 787), University of Illinois College of Medicine, 840 South Wood Street, Room 440-M, Chicago, IL 60612-7323.

Dr. Khuri: Surgical Service (112), Veterans Affairs Boston Healthcare System, 1400 VFW Parkway, West Roxbury, MA 02132.

Dr. Henderson: Cooperative Studies Program Coordinating Center (151K), Hines Veterans Affairs Hospital, Fifth Avenue and Roosevelt Road, Hines, IL 60141.

Dr. Daley: Institute for Health Policy, Massachusetts General Hospital/Partners HealthCare System, 50 Staniford Street, Ninth Floor, Boston, MA 02114.

Author Contributions: Conception and design: A.M. Arozullah, J. Daley.

Analysis and interpretation of the data: A.M. Arozullah.

Drafting of the article: A.M. Arozullah, S.F. Khuri, W.G. Henderson, J. Daley.

Critical revision of the article for important intellectual content: A.M. Arozullah, S.F. Khuri, W.G. Henderson, J. Daley.

Final approval of the article: A.M. Arozullah, S.F. Khuri, W.G. Henderson, J. Daley.

Provision of study materials or patients: S.F. Khuri, W.G. Henderson, J. Daley.

Statistical expertise: A.M. Arozullah, W.G. Henderson.

Obtaining of funding: S.F. Khuri, W.G. Henderson, J. Daley.

Administrative, technical, or logistic support: S.F. Khuri, W.G. Henderson, J. Daley.

Collection and assembly of data: S.F. Khuri, W.G. Henderson, J. Daley.


Ann Intern Med. 2001;135(10):847-857. doi:10.7326/0003-4819-135-10-200111200-00005
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Postoperative pulmonary complications are associated with substantial morbidity and mortality. It has been estimated that nearly one fourth of deaths occurring within 6 days of surgery are related to postoperative pulmonary complications (1). Postoperative infections are also a major source of the morbidity and mortality associated with undergoing surgery. Pneumonia is the most serious postoperative complication that is included in both of these categories. Pneumonia ranks as the third most common postoperative infection, behind urinary tract and wound infection (2). According to the National Nosocomial Infection Surveillance system, pneumonia occurred in 18% of patients after surgery (3). Postoperative pneumonia occurs in 9% to 40% of patients, and the associated mortality rate is 30% to 46%, depending on the type of surgery (1, 4).

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Summary for Patients

Who Gets Pneumonia after Surgery?

The summary below is from the full report titled “Development and Validation of a Multifactorial Risk Index for Predicting Postoperative Pneumonia after Major Noncardiac Surgery.” It is in the 20 November 2001 issue of Annals of Internal Medicine (volume 135, pages 847–857). The authors are AM Arozullah, SF Khuri, WG Henderson, J Daley, and the participants in the National Veterans Affairs Surgical Quality Improvement Program.

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