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The LAS VEGAS risk score for prediction of postoperative pulmonary complications: An observational study
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2018 (English)In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 35, no 9, p. 691-701Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
2018. Vol. 35, no 9, p. 691-701
National Category
Anesthesiology and Intensive Care
Research subject
Anaesthesiology and Intensive Care
Identifiers
URN: urn:nbn:se:uu:diva-365778DOI: 10.1097/EJA.0000000000000845ISI: 000442249300008PubMedID: 29916860OAI: oai:DiVA.org:uu-365778DiVA, id: diva2:1263204
Available from: 2018-11-14 Created: 2018-11-14 Last updated: 2019-04-04Bibliographically approved

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Hedenstierna, Göran

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