Objectives. To determine the pulmonary risk classification using cardiopulmonary risk index (CPRI) after cardiothoeacic surgery in predicting post operative pulmonary complications as compared to Shapiro as the scoring reference.
Specific. To determine CPRI scores in patients undergoing cardiothoracic surgery; To stratify patients using CPRI scores as low, moderate and high risk based on Shapiro scoring; To determine incidence of complications after cardiothoracic surgery according to CPRI scoring; T determine CPRI score best predictive of post operative pulmonary complications.
Methodology. All patients who are >18 years old who underwent elective cardiothoracic surgery were assessed and identified. An informed consent was obtained from all the eligible patients. Preoperative data such as age, sex, BMI, Pulmonary function test, ABG, 12-lead ECG, productive cough, heart and lung PE findings, history of cigarette smoking, as well as presence of other co-morbid diseases were assessed. Patients was scored based on CPRI, each cumulative score was classified as low, moderate or high risk depending on their post operative outcome as to the timing of extubation. Low risk means extubation was instigated immediately after cardiothoracic surgery, whereas moderate risk denotes extubation within 24-48 hours and if more than 48 hours, patient was classified as high risk. Patients were followed up daily and development of postoperative pulmonary complications based on outcome was identified and correlated with the scoring system. The mean values of CPRI for each risk classification was used to determine cut off for w, moderate, high risks based on the variable (CPRI).To determine best cut off of point for CPRI that predict complications, the sensitivy, specificity, PPV and NPV was determined ROC was used to determine the best cut off point. Kappa test was used to determine significance of agreement of score with outcome. A p value≤0.050 is considered significant.
Results. The classification of risk pilmonary post operation complications of CPRI by Shapiro Risk classification. The results showed that there was a significant difference noted as proven by the p value/4 gives a high sensitivity, specificity, NPV as well as PPV. When the CPRI scores were compared between those with and without complications, there was s significant difference noted. The CPRI scores of patients with complications (5.35 ± 1.82) was significantly higher than those without complications (4.36 ± 1.65) with p value=0.002. Comparing the timing of extubation and complications based on CPRI, the results showed that there was a significant difference noted in the xtubation time according to CPRI scoring as proven by the p value of
Conclusion. The results of the study showed that the CPRI scores ranged from 1 to 9 with a mean of 4.98. Of the 131 subjects, 3 (2.3%) were classified as high risk, 114 (87.0%) were classified as moderate risk and 14 (10.7) were classified as high risk based from Shapiro scoring. There were 82 (62.6%) of patients with complications noted The occurence of complications increases with increasing CPRI scores and a CPRI scorre of ≥4 best predicts pulmonary complications.