Ary Serpa Neto1, Luiz Guilherme V da Costa, Sabrine N T Hemmes, Jaume Canet, Göran Hedenstierna, Samir Jaber, Michael Hiesmayr, Markus W Hollmann, Gary H Mills, Marcos F Vidal Melo, Rupert Pearse, Christian Putensen, Werner Schmid, Paolo Severgnini, Hermann Wrigge, Marcelo Gama de Abreu, Paolo Pelosi, Marcus J Schultz. 1. From the Hospital Israelita Albert Einstein, São Paulo, Brazil (ASN, LGVC), Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands (SNTH), Hospital Universitari Germans Trias I Pujol, Barcelona, Spain (JC), University Hospital Uppsula, Uppsala, Sweden (GH), Saint Eloi University Hospital, Montpellier, France (SJ), Medical University Vienna, Vienna, Austria (MH,WS), Academic Medical Center, Amsterdam, the Netherlands (MWH, MJS), Sheffield Teaching Hospitals, Sheffield, UK (GHM), Massachusetts General Hospital, Boston, USA (MFVM), Queen Mary University of London, London, UK (RP), University Hospital Bonn, Bonn, Germany (CP), University of Insubria, Varese, Italy (PS), University of Leipzig, Leipzig, Germany (HW), University Hospital Dresden, Dresden, Germany (MGA), Ospedale Policlinico San Martino - IRCCS per l'Oncologia, University of Genoa, Genoa, Italy (PP).
Abstract
BACKGROUND: Currently used pre-operative prediction scores for postoperative pulmonary complications (PPCs) use patient data and expected surgery characteristics exclusively. However, intra-operative events are also associated with the development of PPCs. OBJECTIVE: We aimed to develop a new prediction score for PPCs that uses both pre-operative and intra-operative data. DESIGN: This is a secondary analysis of the LAS VEGAS study, a large international, multicentre, prospective study. SETTINGS: A total of 146 hospitals across 29 countries. PATIENTS: Adult patients requiring intra-operative ventilation during general anaesthesia for surgery. INTERVENTIONS: The cohort was randomly divided into a development subsample to construct a predictive model, and a subsample for validation. MAIN OUTCOME MEASURES: Prediction performance of developed models for PPCs. RESULTS: Of the 6063 patients analysed, 10.9% developed at least one PPC. Regression modelling identified 13 independent risk factors for PPCs: six patient characteristics [higher age, higher American Society of Anesthesiology (ASA) physical score, pre-operative anaemia, pre-operative lower SpO2 and a history of active cancer or obstructive sleep apnoea], two procedure-related features (urgent or emergency surgery and surgery lasting ≥ 1 h), and five intra-operative events [use of an airway other than a supraglottic device, the use of intravenous anaesthetic agents along with volatile agents (balanced anaesthesia), intra-operative desaturation, higher levels of positive end-expiratory pressures > 3 cmH2O and use of vasopressors]. The area under the receiver operating characteristic curve of the LAS VEGAS risk score for prediction of PPCs was 0.78 [95% confidence interval (95% CI), 0.76 to 0.80] for the development subsample and 0.72 (95% CI, 0.69 to 0.76) for the validation subsample. CONCLUSION: The LAS VEGAS risk score including 13 peri-operative characteristics has a moderate discriminative ability for prediction of PPCs. External validation is needed before use in clinical practice. TRIAL REGISTRATION: The study was registered at Clinicaltrials.gov, number NCT01601223.
BACKGROUND: Currently used pre-operative prediction scores for postoperative pulmonary complications (PPCs) use patient data and expected surgery characteristics exclusively. However, intra-operative events are also associated with the development of PPCs. OBJECTIVE: We aimed to develop a new prediction score for PPCs that uses both pre-operative and intra-operative data. DESIGN: This is a secondary analysis of the LAS VEGAS study, a large international, multicentre, prospective study. SETTINGS: A total of 146 hospitals across 29 countries. PATIENTS: Adult patients requiring intra-operative ventilation during general anaesthesia for surgery. INTERVENTIONS: The cohort was randomly divided into a development subsample to construct a predictive model, and a subsample for validation. MAIN OUTCOME MEASURES: Prediction performance of developed models for PPCs. RESULTS: Of the 6063 patients analysed, 10.9% developed at least one PPC. Regression modelling identified 13 independent risk factors for PPCs: six patient characteristics [higher age, higher American Society of Anesthesiology (ASA) physical score, pre-operative anaemia, pre-operative lower SpO2 and a history of active cancer or obstructive sleep apnoea], two procedure-related features (urgent or emergency surgery and surgery lasting ≥ 1 h), and five intra-operative events [use of an airway other than a supraglottic device, the use of intravenous anaesthetic agents along with volatile agents (balanced anaesthesia), intra-operative desaturation, higher levels of positive end-expiratory pressures > 3 cmH2O and use of vasopressors]. The area under the receiver operating characteristic curve of the LAS VEGAS risk score for prediction of PPCs was 0.78 [95% confidence interval (95% CI), 0.76 to 0.80] for the development subsample and 0.72 (95% CI, 0.69 to 0.76) for the validation subsample. CONCLUSION: The LAS VEGAS risk score including 13 peri-operative characteristics has a moderate discriminative ability for prediction of PPCs. External validation is needed before use in clinical practice. TRIAL REGISTRATION: The study was registered at Clinicaltrials.gov, number NCT01601223.
Authors: Ary Serpa Neto; Sabrine N T Hemmes; Carmen S V Barbas; Martin Beiderlinden; Michelle Biehl; Jan M Binnekade; Jaume Canet; Ana Fernandez-Bustamante; Emmanuel Futier; Ognjen Gajic; Göran Hedenstierna; Markus W Hollmann; Samir Jaber; Alf Kozian; Marc Licker; Wen-Qian Lin; Andrew D Maslow; Stavros G Memtsoudis; Dinis Reis Miranda; Pierre Moine; Thomas Ng; Domenico Paparella; Christian Putensen; Marco Ranieri; Federica Scavonetto; Thomas Schilling; Werner Schmid; Gabriele Selmo; Paolo Severgnini; Juraj Sprung; Sugantha Sundar; Daniel Talmor; Tanja Treschan; Carmen Unzueta; Toby N Weingarten; Esther K Wolthuis; Hermann Wrigge; Marcelo Gama de Abreu; Paolo Pelosi; Marcus J Schultz Journal: Anesthesiology Date: 2015-07 Impact factor: 7.892
Authors: A J Berry; R B Smith; W S Weintraub; E L Chaikof; T F Dodson; A B Lumsden; A A Salam; V Weiss; S Konigsberg Journal: J Vasc Surg Date: 2001-02 Impact factor: 4.268
Authors: Conor H Blanco; John B Stein; Gregory L Barinsky; Christina H Fang; Jordon G Grube; Roger E Turbin; Jean Anderson Eloy Journal: Am J Otolaryngol Date: 2020-09-23 Impact factor: 1.808
Authors: Ashish K Khanna; Sergio D Bergese; Carla R Jungquist; Hiroshi Morimatsu; Shoichi Uezono; Simon Lee; Lian Kah Ti; Richard D Urman; Robert McIntyre; Carlos Tornero; Albert Dahan; Leif Saager; Toby N Weingarten; Maria Wittmann; Dennis Auckley; Luca Brazzi; Morgan Le Guen; Roy Soto; Frank Schramm; Sabry Ayad; Roop Kaw; Paola Di Stefano; Daniel I Sessler; Alberto Uribe; Vanessa Moll; Susan J Dempsey; Wolfgang Buhre; Frank J Overdyk Journal: Anesth Analg Date: 2020-10 Impact factor: 6.627