Gupta Postoperative Pneumonia Risk

Helps screen patients at increased risk of postoperative pneumonia based on available clinical data.

Refer to the text below the calculator for more information about the model and the original development and validation study.


This risk screening tool can help identify patients at increased risk of postoperative pneumonia, which is a common complication of surgery, one associated with marked morbidity and mortality.

Seven preoperative predictors of postoperative pneumonia were identified via multivariate logistic regression analysis in the study by Gupta et al.


Postoperative Pneumonia Risk  (%) = ex / (1 + ex)

x = −2.8977 + sum of the values of the selected variables (can be found in the text below).


Age
COPD COPD causing functional disability or hospitalization, or FEV1 <75%
Functional status
ASA Physical Status
Sepsis
Smoking within last year
Type of procedure
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Gupta Postoperative Pneumonia Risk Screening

This risk screening tool can help identify patients at increased risk of postoperative pneumonia, which is a common complication of surgery, one associated with marked morbidity and mortality.

Postoperative pneumonia is defined as either:

  • hospital-acquired pneumonia (developing 48 - 72 h after admission);
  • ventilator-associated pneumonia (developing 48 - 72 h after endotracheal intubation).

The study by Gupta et al. is based on a multicenter data set from the American College of Surgeons' National Surgical Quality Improvement Program, which was analysed via univariate and multivariate logistic regression.

The 2007 part of the dataset was used as training set (211,410) whilst the 2008 part of the dataset was used as validation set (257,385).

1.8% of patients from the dataset experienced postoperative pneumonia and a significantly higher 30-day mortality.

Seven preoperative predictors of postoperative pneumonia were identified via multivariate logistic regression analysis and resulted in the below instructions on how to calculate the risk:

Postoperative Pneumonia Risk (%) = ex / (1 + ex)

Where x = −2.8977 + sum of the values of the selected variables that can be found in the table below:

Gupta Score Item Answer Choices Value
Patient Age n/a Age x 0.0144
COPD causing functional disability or hospitalization, or FEV1 <75% No -0.4553
Yes 0
Functional status Independent 0
Partially dependent 0.7653
Totally dependent 0.9400
ASA Physical Status 1: Normal healthy patient -3.0225
2: Mild systemic disease -1.6057
3: Severe systemic disease -0.4915
4: Severe systemic disease that is a constant threat to life 0.0123
5: Moribund, not expected to survive without surgery 0
Sepsis None -0.7641
Preoperative systemic inflammatory response syndrome 0
Preoperative sepsis -0.0842
Preoperative septic shock 0.1048
Smoking within last year No -0.4306
Yes 0
Type of procedure Anorectal -0.8470
Aortic 0.7178
Bariatric -0.6282
Brain 0.6841
Breast -2.3318
Cardiac 0.1382
ENT (except thyroid/parathyroid) -0.3665
Foregut or hepatopancreatobiliary 1.0660
Gallbladder, appendix, adrenals, or spleen -0.3951
Hernia (ventral, inguinal, femoral) 0
Intestinal 0.6169
Neck (thyroid/parathyroid) -0.0872
Obstetric/gynecologic -0.4101
Orthopedic and non-vascular extremity -0.5415
Other abdominal 0.4021
Peripheral vascular -0.4519
Skin -0.5075
Spine -0.5672
Non-esophageal thoracic 0.8901
Vein -1.4760
Urology 0.1076

The tool was further validated with similar model performance (C statistic: 0.860 and 0.855, respectively) and excellent predictive performance.

 

References

Original reference

Gupta H, Gupta PK, Schuller D, Fang X, Miller WJ, Modrykamien A, Wichman TO, Morrow LE. Development and validation of a risk calculator for predicting postoperative pneumonia. Mayo Clin Proc. 2013; 88(11):1241-9.

Other reference

Chughtai M, Gwam CU, Mohamed N, Khlopas A, Newman JM, Khan R, Nadhim A, Shaffiy S, Mont MA. The Epidemiology and Risk Factors for Postoperative Pneumonia. J Clin Med Res. 2017; 9(6):466-475.


Specialty: Surgery

Year Of Study: 2013

Article By: Denise Nedea

Published On: November 1, 2020

Last Checked: November 1, 2020

Next Review: November 1, 2025