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 SpO(2) 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 intraoperative 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 cmH(2)O 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.
The LAS VEGAS risk score for prediction of postoperative pulmonary complications An observational study
Severgnini, Paolo;
2018-01-01
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 SpO(2) 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 intraoperative 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 cmH(2)O 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.
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