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

Ary Serpa Neto, Luiz Guilherme V da Costa, Sabrine N T 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, LAS VEGAS, Ary Serpa Neto, Luiz Guilherme V da Costa, Sabrine N T 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, LAS VEGAS

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.