Research article

Anticipating pulmonary complications after thoracotomy: the FLAM Score

Francesco Leo¹ , Nicolas Venissac¹ , Daniel Pop¹ , Marylene Anziani² , Maria E Leon³ and Jérôme Mouroux¹

¹  Thoracic Surgery Department, Nice University Hospital, Nice, France

²  Physiotherapy Department, Nice University Hospital, Nice, France

³  Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy

author email corresponding author email

Journal of Cardiothoracic Surgery 2006, 1:34doi:10.1186/1749-8090-1-34

Published:	6 October 2006

Abstract

Objective

Pulmonary complications after thoracotomy are the result of progressive changes in the respiratory status of the patient. A multifactorial score (FLAM score) was developed to identify postoperatively patients at higher risk for pulmonary complications at least 24 hours before the clinical diagnosis.

Methods

The FLAM score, created in 2002, is based on 7 parameters (dyspnea, chest X-ray, delivered oxygen, auscultation, cough, quality and quantity of bronchial secretions). To validate the FLAM score, we prospectively calculated scores during the first postoperative week in 300 consecutive patients submitted to posterolateral thoracotomy.

Results

During the study, 60 patients (20%) developed pulmonary complications during the postoperative period. The FLAM score progressively increased in complicated patients until the fourth postoperative day (mean 13.5 ± 11.9). FLAM scores in patients with complications were significantly higher (p < 0.05) at least 24 hours before the clinical diagnosis of complication, compared to FLAM scores in uncomplicated patients. ROC curves analysis showed that the cut-off value of FLAM with the best sensitivity and specificity for pulmonary complications was 9 (area under the curve 0.97). Based on the highest FLAM scores recorded, 4 risk classes were identified with increasing incidence of pulmonary complications and mortality.

Conclusion

Changes in FLAM score were evident at least 24 hours before the clinical diagnosis of pulmonary complications.

FLAM score can be used to categorize patients according to risk of respiratory morbidity and mortality and could be a useful tool in the postoperative management of patients undergoing thoracotomy.