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Ann Thorac Surg 2005;79:2199-2200
© 2005 The Society of Thoracic Surgeons

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Correspondence

Risk Factors for Respiratory Failure: Differentiating Association and Outcome

The Alfred/Deakin Nursing Research Centre, School of Nursing, Deakin University, 221 Burwood Hwy, Burwood, Melbourne VIC 3125, Australia

(E-mail: rwynne{at}deakin.edu.au).

To the Editor:

Canver and Chanda [1] identify factors that increase the risk of respiratory failure after coronary artery bypass grafting. Established difficulties associated with predicting outcome after this operation include ambiguous factor and outcome definitions [2], questionable data reliability [3], variability in methodological approach [4], and the continued neglect of postoperative measures as indicators of complication risk or outcome [5]. Outcomes must be important to patients, relatively common, and linked logically and causally to service providers [3].

The authors claim the inclusion of postoperative variables in a multivariate analysis designed to predict the risk factors for the need of postoperative mechanical ventilatory support for more than 72 hours. This outcome has major implications for patients and providers. However, Canver and Chanda fail to make the important distinction between variables as predictors of increased risk and variables that are, by circumstance, associated with the outcome of interest. Examining complications as predictors disregards the multifactor contribution of antecedents to complications that in this instance can also influence the need of prolonged ventilatory support. Patients will not be extubated in the context of hemodynamic instability and inability to safely maintain a patent airway secondary to septicemia, stroke, or bleeding that requires reexploration.

Postoperative patient and process variables have long been neglected, as is reflected in predictive models that account for small proportions of variation in patient outcome. Although efforts of Canver and Chanda to overcome this discrepancy are acknowledged, the value of postoperative patient factors and care processes in combination warrants further exploration for the adequate prediction of pulmonary dysfunction after cardiac surgical procedures.

	References

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1. Canver CC, Chanda J. Intraoperative and postoperative risk factors for respiratory failure after coronary bypass Ann Thorac Surg 2003;75:853-858.[Abstract/Free Full Text]
2. Turner JS, Morgan CJ, Thakrar B, Pepper JR. Difficulties in predicting outcome in cardiac surgery patients Crit Care Med 1995;23:1843-1850.[Medline]
3. Iezzoni LI. Using risk-adjusted outcomes to assess clinical practicean overview of issues pertaining to risk adjustment. Ann Thorac Surg 1994;58:1822-1826.[Abstract]
4. Fortescue EB, Kahn K, Bates DW. Prediction rules for complications in coronary bypass surgerya comparison and methodological critique. Med Care 2000;38:820-835.[Medline]
5. Shroyer AL, London MJ, Sethi GK, Marshall G, Grover FL, Hammermeister KE. Relationships between patient-related risk factors, processes, structures, and outcomes of cardiac surgical care. Conceptual models Med Care 1995;33(10 Suppl):OS26-OS34.[Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Wynne, R. M. Search for Related Content PubMed Articles by Wynne, R. M. Related Collections Coronary disease Related Article