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).
Eur J Anaesthesiol. 2018 Sep;35(9):691-701. doi: 10.1097/EJA.0000000000000845.
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.
We aimed to develop a new prediction score for PPCs that uses both pre-operative and intra-operative data.
This is a secondary analysis of the LAS VEGAS study, a large international, multicentre, prospective study.
A total of 146 hospitals across 29 countries.
Adult patients requiring intra-operative ventilation during general anaesthesia for surgery.
The cohort was randomly divided into a development subsample to construct a predictive model, and a subsample for validation.
Prediction performance of developed models for PPCs.
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.
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 study was registered at Clinicaltrials.gov, number NCT01601223.
目前用于术后肺部并发症（PPC）的预测评分仅使用患者数据和预期手术特征。然而，术中事件也与 PPC 的发生有关。
我们旨在开发一种新的 PPC 预测评分，该评分同时使用术前和术中数据。
这是一项大型国际多中心前瞻性研究 LAS VEGAS 研究的二次分析。
共有 29 个国家的 146 家医院参与。
需要全身麻醉下术中通气的成年手术患者。
队列被随机分为构建预测模型的发展子样本和验证子样本。
开发的 PPC 预测模型的预测性能。
在分析的 6063 名患者中，10.9%至少发生了一种 PPC。回归模型确定了 PPC 的 13 个独立危险因素：6 个患者特征[年龄较高、美国麻醉医师协会（ASA）身体评分较高、术前贫血、术前较低的 SpO2 和癌症或阻塞性睡眠呼吸暂停病史]、两个与手术相关的特征（紧急或急诊手术和手术持续时间≥1 小时）以及 5 个术中事件[使用非声门上设备的气道、静脉麻醉剂与挥发性麻醉剂（平衡麻醉）联合使用、术中低氧血症、呼气末正压水平较高（PEEP）>3cmH2O 和使用血管加压药]。LAS VEGAS 风险评分预测 PPC 的受试者工作特征曲线下面积（AUC）在发展子样本中为 0.78（95%置信区间[95%CI]，0.76-0.80），在验证子样本中为 0.72（95%CI，0.69-0.76）。
包括 13 个围手术期特征的 LAS VEGAS 风险评分对 PPC 的预测具有中等的区分能力。在临床实践中使用之前需要进行外部验证。
该研究在 Clinicaltrials.gov 注册，编号为 NCT01601223。
