The LAS VEGAS risk score for prediction of postoperative pulmonary complications An observational study

Authors	NETO AS DA Costa LGV HEMMES SNT CANET J HEDENSTIERNA G JABER S HIESMAYR M HOLLMANN MW MILLS GH MELO MFV PEARSE R PUTENSEN C SCHMID W SEVERGNINI P WRIGGE H DE Abreu MG PELOSI P SCHULTZ MJ ŠTOURAČ Petr HARAZIM Hana SMÉKALOVÁ Olga KOSINOVÁ Martina KOLACEK tomas HUDÁČEK Kamil
Year of publication	2018
Type	Article in Periodical
Magazine / Source	European Journal of Anaesthesiology
MU Faculty or unit	Faculty of Medicine
Citation
Doi	http://dx.doi.org/10.1097/EJA.0000000000000845
Description	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.