DAGDA score and its evidence-based pneumonia-prevention programme
Abstract
Aim
The mortality rate of the postoperative pneumonia group is significantly higher than that of non-pneumonia group. Five of 38 risk factors were found to be significantly related to postoperative pneumonia (P < 0.05) after univariable logistic regression and then multivariable logistic regression analysis: (i) Dependence of activity of daily living; (ii) presence of Ascites; (iii) General anaesthesia; (iv) preoperative Dyspnoea; and (v) ASA (American Society of Anesthesiologists) score ≥3. The DAGDA score was formulated by using these significant risk factors to predict high-risk patients. The maximum DAGDA score is 18, with an area under the receiver operating characteristic curve of 0.774 (95 per cent confidence interval: 0.716–0.837). Sensitivity and specificity of the DAGDA score with a cut-off point of 8 are 73.6 and 73.4 per cent, respectively. The external validation of the DAGDA score was examined by using other 4495 patients, which resulted in similar findings. A multidisciplinary team (MDT), including surgeons, respiratory physicians, surgical nursing staff and physiotherapists, was formed, and proactive measures were applied to patients at high risk of developing postoperative pneumonia.
Patients and Methods
The present study was a prospective cohort study to compare the postoperative pneumonia rate and pneumonia-related mortality before and after this programme.
Results
After the implementation of the pneumonia-prevention programme, there was a decrease in the postoperative pneumonia rate from 4.1 to 3.7 per cent. The 30-day pneumonia-related mortality rate significantly dropped from 31.9 to 4.8 per cent (P = 0.016).
Conclusion
The DAGDA score and the MDT-led pneumonia-prevention programme are useful to decrease postoperative pneumonia and prevent pneumonia-related mortality.
