학술논문
The LAS VEGAS risk score for prediction of postoperative pulmonary complications: An observational study.
Document Type
Academic Journal
Author
Neto, Ary Serpa; da Costa, Luiz Guilherme V.; Hemmes, Sabrine N. T.; Canet, Jaume; Hedenstierna, Göran; Jaber, Samir; Hiesmayr, Michael; Hollmann, Markus W.; Mills, Gary H.; Melo, Marcos F. Vidal; Pearse, Rupert; Putensen, Christian; Schmid, Werner; Severgnini, Paolo; Wrigge, Hermann; de Abreu, Marcelo Gama; Pelosi, Paolo; Schultz, Marcus J.; Vidal Melo, Marcos F; Gama de Abreu, Marcelo
Source
Subject
Language
English
ISSN
0265-0215
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.