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

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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 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.
Keywords
END-EXPIRATORY PRESSURE, SLEEP-APNEA SYNDROME, LUNG INJURY, MULTICENTER, COHORT, GENERAL-ANESTHESIA, RECTAL-CANCER, SURGERY, MORTALITY, VENTILATION, VALIDATION

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MLA
Neto, Ary Serpa, Luiz Guilherme da Costa V, Sabrine NT Hemmes, et al. “The LAS VEGAS Risk Score for Prediction of Postoperative Pulmonary Complications : an Observational Study.” EUROPEAN JOURNAL OF ANAESTHESIOLOGY 35.9 (2018): 691–701. Print.
APA
Neto, A. S., da Costa, L. G., V., Hemmes, S. N., Canet, J., Hedenstierna, G., Jaber, S., Hiesmayr, M., et al. (2018). The LAS VEGAS risk score for prediction of postoperative pulmonary complications : an observational study. EUROPEAN JOURNAL OF ANAESTHESIOLOGY, 35(9), 691–701.
Chicago author-date
Neto, Ary Serpa, Luiz Guilherme da Costa V, Sabrine NT Hemmes, Jaume Canet, Göran Hedenstierna, Samir Jaber, Michael Hiesmayr, et al. 2018. “The LAS VEGAS Risk Score for Prediction of Postoperative Pulmonary Complications : an Observational Study.” European Journal of Anaesthesiology 35 (9): 691–701.
Chicago author-date (all authors)
Neto, Ary Serpa, Luiz Guilherme da Costa V, Sabrine NT Hemmes, Jaume Canet, Göran Hedenstierna, Samir Jaber, Michael Hiesmayr, Markus W Hollmann, Gary H Mills, Marcos F Vidal Melo, Rupert Pearse, Christian Putensen, Werner Schmid, Paolo Severgnini, Hermann Wrigge, Marcelo Gama de Abreu, Paolo Pelosi, Marcus J Schultz, the LAS VEGAS Investigators, Stefan De Hert, Luc De Baerdemaeker, Bjorn Heyse, Jurgen Van Limmen, PIET WYFFELS, TOM JACOBS, NATHALIE ROELS, and Ann De Bruyne. 2018. “The LAS VEGAS Risk Score for Prediction of Postoperative Pulmonary Complications : an Observational Study.” European Journal of Anaesthesiology 35 (9): 691–701.
Vancouver
1.
Neto AS, da Costa LG V, Hemmes SN, Canet J, Hedenstierna G, Jaber S, et al. The LAS VEGAS risk score for prediction of postoperative pulmonary complications : an observational study. EUROPEAN JOURNAL OF ANAESTHESIOLOGY. 2018;35(9):691–701.
IEEE
[1]
A. S. Neto et al., “The LAS VEGAS risk score for prediction of postoperative pulmonary complications : an observational study,” EUROPEAN JOURNAL OF ANAESTHESIOLOGY, vol. 35, no. 9, pp. 691–701, 2018.
@article{8573101,
  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 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.},
  author       = {Neto, Ary Serpa and da Costa, Luiz Guilherme, V and Hemmes, Sabrine NT and Canet, Jaume and Hedenstierna, Göran and Jaber, Samir and Hiesmayr, Michael and Hollmann, Markus W and Mills, Gary H and Melo, Marcos F Vidal and Pearse, Rupert and Putensen, Christian and Schmid, Werner and Severgnini, Paolo and Wrigge, Hermann and de Abreu, Marcelo Gama and Pelosi, Paolo and Schultz, Marcus J and LAS VEGAS Investigators, the and De Hert, Stefan and De Baerdemaeker, Luc and Heyse, Bjorn and Van Limmen, Jurgen and WYFFELS, PIET and JACOBS, TOM and ROELS, NATHALIE and De Bruyne, Ann},
  issn         = {0265-0215},
  journal      = {EUROPEAN JOURNAL OF ANAESTHESIOLOGY},
  keywords     = {END-EXPIRATORY PRESSURE,SLEEP-APNEA SYNDROME,LUNG INJURY,MULTICENTER,COHORT,GENERAL-ANESTHESIA,RECTAL-CANCER,SURGERY,MORTALITY,VENTILATION,VALIDATION},
  language     = {eng},
  number       = {9},
  pages        = {691--701},
  title        = {The LAS VEGAS risk score for prediction of postoperative pulmonary complications : an observational study},
  url          = {http://dx.doi.org/10.1097/EJA.0000000000000845},
  volume       = {35},
  year         = {2018},
}

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