Page 130 - HA Convention 2015

Service Priorities and Programmes Free Papers

SPP4.7 Clinical Safety and Quality Service II 16:15 Room 221

Monday, 18 May How to Prevent Post-operative Pneumonia?
Wong KKF, Fung JTK, Leung SK
Department of Surgery, Tuen Mun Hospital, Hong Kong

Introduction

After major operations, the mortality rate of patients having post-operative pneumonia is significantly higher than that of
patients having no pneumonia.

Objectives

(1) To identify risk factors of post-operative pneumonia; (2) to construct a predictive score to identify high-risk patients; and (3)
to adopt protective measures to reduce the occurrence of post-operative pneumonia.

Methodology

1,742 patients receiving major and ultra-major operations (July 2012 to June 2013) were recruited and data were retrieved
from the Surgical Outcomes Monitoring and Improvement Programme (SOMIP) database. 38 variables were analysed by
using uni-variable and multi-variable logistic regression model. A scoring system was formulated by using the significant
risk factors to predict the high-risk patients. Measures shown to be effective in preventing post-operative pneumonia from
literature review will be applied.

Results

Variables, including Activities of Daily Living (ADL) Dependence, Ascites, General Anaesthesia, pre-operative Dyspnea and
American Society of Anaesthesiologists (ASA) score >= 3, were found to be significant out of 38 variables (7 demographic,
20 pre-operative and 11 operative or disease related variables). They formed the basis of the DAGDA score and were
weighed individually according to their respective proportion (B-value). DAGDA score = f(Dependence) x 3 + f(ASA >=3)
x 2 + f(GA) x 6 + f(pre-operative Dyspnoea) x 3 + f(Ascites) x 4 Maximum DAGDA score was 18 with area under receiver
operating characteristics (ROC) curve 0.776 (95% CI: 0.716 – 0.837). Sensitivity and specificity of DAGDA score with cut-off
point of 8 were 73.6 % and 72.8 % respectively. Validation of DAGDA score was examined by using another cohort group of
1,330 patients. The area under ROC curve 0.76. Sensitivity and specificity using the same cut-off point of 8 were 84.4% and
63.2% respectively. Literature was reviewed and measures shown to be effective in preventing post-operative pneumonia
were selected. Integrated Patients Care Plan, with participation of different stakeholders (supporting and nursing staffs,
physiotherapists, ICU, respiratory physicians), would be applied to those high-risk patients with DAGDA score >=8.

Conclusion

ADL dependence, ascites, GA, pre-operative dyspnoea and ASA score >=3 are significant risk factors associated with post-
operative pneumonia. DAGDA score can be used to predict the high-risk patients. Preventive measures are formulated for
those high risk patients (DAGDA score >=8) in order to prevent this dreadful complication.

HOSPITAL AUTHORITY CONVENTION 2015

128