Abstract
Background: Stratifying risk of postoperative pulmonary complications (PPCs) after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. This study aimed to identify and validate prognostic models against a new consensus definition of PPCs in an international, prospective cohort study.
Methods: A systematic review was conducted in accordance with PRISMA guidelines (registered at: https://osf.io/ceypm) to identify risk prediction models for PPC following abdominal surgery published before 1st March 2020. External validation of existing models was performed within a prospective cohort study of adult patients undergoing major abdominal surgery. Data were collected between 1 January and 30 April 2019 in the UK, Ireland and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day PPC rate (Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC) definition).
Findings: Twenty-nine unique prognostic models were identified from 121 full-text reports. Only 4 models (13.8%) had been externally validated. Data to validate six eligible models were collected in the cohort study. Data from 11,591 patients was available, with an overall PPC rate of 7.8% (n=903). The Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score demonstrated the best discrimination (AUC: 0.700 (95% CI: 0.683 to 0.717), with none displaying good discrimination (AUC >0.7).
Interpretation: In pre-pandemic data, variability in risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during pandemic recovery and beyond, novel risk stratification tools are required.
Methods: A systematic review was conducted in accordance with PRISMA guidelines (registered at: https://osf.io/ceypm) to identify risk prediction models for PPC following abdominal surgery published before 1st March 2020. External validation of existing models was performed within a prospective cohort study of adult patients undergoing major abdominal surgery. Data were collected between 1 January and 30 April 2019 in the UK, Ireland and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day PPC rate (Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC) definition).
Findings: Twenty-nine unique prognostic models were identified from 121 full-text reports. Only 4 models (13.8%) had been externally validated. Data to validate six eligible models were collected in the cohort study. Data from 11,591 patients was available, with an overall PPC rate of 7.8% (n=903). The Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score demonstrated the best discrimination (AUC: 0.700 (95% CI: 0.683 to 0.717), with none displaying good discrimination (AUC >0.7).
Interpretation: In pre-pandemic data, variability in risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during pandemic recovery and beyond, novel risk stratification tools are required.
| Original language | English |
|---|---|
| Pages (from-to) | e520-e531 |
| Journal | The Lancet Digital Health |
| Volume | 4 |
| Issue number | 7 |
| DOIs | |
| Publication status | Published - 1 Jul 2022 |