The LAS VEGAS risk score for prediction of postoperative pulmonary complications : An observational study
(2018) In European Journal of Anaesthesiology 35(9). p.691-701- 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... (More) - 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. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/9c38fa6f-b0f5-41af-991d-793b280173aa
- author
- Serpa Neto, Ary and Schultz, Marcus J
- contributor
- Jawad, Monir
LU
- author collaboration
- publishing date
- 2018-09
- type
- Contribution to journal
- publication status
- published
- subject
- in
- European Journal of Anaesthesiology
- volume
- 35
- issue
- 9
- pages
- 691 - 701
- publisher
- European Society of Anaesthesiology
- external identifiers
-
- scopus:85058805384
- ISSN
- 1365-2346
- DOI
- 10.1097/EJA.0000000000000845
- language
- English
- LU publication?
- no
- id
- 9c38fa6f-b0f5-41af-991d-793b280173aa
- date added to LUP
- 2021-02-24 23:34:38
- date last changed
- 2022-04-27 00:27:33
@article{9c38fa6f-b0f5-41af-991d-793b280173aa,
abstract = {{BACKGROUND <br>
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.<br>
<br>
OBJECTIVE <br>
We aimed to develop a new prediction score for PPCs that uses both pre-operative and intra-operative data.<br>
<br>
DESIGN <br>
This is a secondary analysis of the LAS VEGAS study, a large international, multicentre, prospective study.<br>
<br>
SETTINGS <br>
A total of 146 hospitals across 29 countries.<br>
<br>
PATIENTS <br>
Adult patients requiring intra-operative ventilation during general anaesthesia for surgery.<br>
<br>
INTERVENTIONS <br>
The cohort was randomly divided into a development subsample to construct a predictive model, and a subsample for validation.<br>
<br>
MAIN OUTCOME MEASURES <br>
Prediction performance of developed models for PPCs.<br>
<br>
RESULTS <br>
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.<br>
<br>
CONCLUSION <br>
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.<br>
<br>
TRIAL REGISTRATION <br>
The study was registered at Clinicaltrials.gov, number NCT01601223.}},
author = {{Serpa Neto, Ary and Schultz, Marcus J}},
issn = {{1365-2346}},
language = {{eng}},
number = {{9}},
pages = {{691--701}},
publisher = {{European Society of Anaesthesiology}},
series = {{European Journal of Anaesthesiology}},
title = {{The LAS VEGAS risk score for prediction of postoperative pulmonary complications : An observational study}},
url = {{http://dx.doi.org/10.1097/EJA.0000000000000845}},
doi = {{10.1097/EJA.0000000000000845}},
volume = {{35}},
year = {{2018}},
}