title: Prospective external validation of a predictive score for postoperative pulmonary complications.
abstract: BACKGROUND
  No externally validated risk score for postoperative pulmonary complications (PPCs) is currently available. The authors tested the generalizability of the Assess Respiratory Risk in Surgical Patients in Catalonia risk score for PPCs in a large European cohort (Prospective Evaluation of a RIsk Score for postoperative pulmonary COmPlications in Europe).
  
  
  METHODS
  Sixty-three centers recruited 5,859 surgical patients receiving general, neuraxial, or plexus block anesthesia. The Assess Respiratory Risk in Surgical Patients in Catalonia factors (age, preoperative arterial oxygen saturation in air, acute respiratory infection during the previous month, preoperative anemia, upper abdominal or intrathoracic surgery, surgical duration, and emergency surgery) were recorded, along with PPC occurrence (respiratory infection or failure, bronchospasm, atelectasis, pleural effusion, pneumothorax, or aspiration pneumonitis). Discrimination, calibration, and diagnostic accuracy measures of the Assess Respiratory Risk in Surgical Patients in Catalonia score's performance were calculated for the Prospective Evaluation of a RIsk Score for postoperative pulmonary COmPlications in Europe cohort and three subsamples: Spain, Western Europe, and Eastern Europe.
  
  
  RESULTS
  The full Prospective Evaluation of a RIsk Score for postoperative pulmonary COmPlications in Europe data set included 5,099 patients; 725 PPCs were recorded for 404 patients (7.9%). The score's discrimination was good: c-statistic (95% CI), 0.80 (0.78 to 0.82). Predicted versus observed PPC rates for low, intermediate, and high risk were 0.87 and 3.39% (score <26), 7.82 and 12.98% (≥ 26 and <45), and 38.13 and 38.01% (≥ 45), respectively; the positive likelihood ratio for a score of 45 or greater was 7.12 (5.93 to 8.56). The score performed best in the Western Europe subsample-c-statistic, 0.87 (0.83 to 0.90) and positive likelihood ratio, 11.56 (8.63 to 15.47)-and worst in the Eastern Europe subsample. The predicted (5.5%) and observed (5.7%) PPC rates were most similar in the Spain subsample.
  
  
  CONCLUSIONS
  The Assess Respiratory Risk in Surgical Patients in Catalonia score predicts three levels of PPC risk in hospitals outside the development setting. Performance differs between geographic areas.
authors.affiliation: From the Department of Anesthesiology (V.M.) and Department of Anesthesiology and Postoperative Care Unit (J.C.), Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Department of Anesthesiology, Fundació, Puigvert, Barcelona, Spain (S.S.); Department of Anesthesiology, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona, Barcelona, Spain (L.G.); Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Dresden, Germany (M.G.d.A.); Department of Anesthesia and Critical Care, Hospital Clínico Universitario, University of Valencia, Valencia, Spain (J.B.); Department of Anesthesiology and Critical Care, Université Pierre et Marie Curie-Paris VI, CHU Pitié-Salpêtrière, Paris, France (O.L.); Department of Anesthesiology and Intensive Care Medicine, University of Bonn, Bonn, Germany (A.H.); and Department of Surgical Sciences and Integrated Diagnostics, IRCCS San Martino Hospital-IST, University of Genoa, Genoa, Italy (P.P.).
authors.forename: Valentín
authors.initials: V
authors.lastname: Mazo
authors.forename: Sergi
authors.initials: S
authors.lastname: Sabaté
authors.forename: Jaume
authors.initials: J
authors.lastname: Canet
authors.forename: Lluís
authors.initials: L
authors.lastname: Gallart
authors.forename: Marcelo Gama
authors.initials: MG
authors.lastname: de Abreu
authors.forename: Javier
authors.initials: J
authors.lastname: Belda
authors.forename: Olivier
authors.initials: O
authors.lastname: Langeron
authors.forename: Andreas
authors.initials: A
authors.lastname: Hoeft
authors.forename: Paolo
authors.initials: P
authors.lastname: Pelosi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000150:complications; D002138:Calibration; D015331:Cohort Studies; D003625:Data Collection; D004630:Emergencies; D005260:Female; D006801:Humans; D007902:Length of Stay; D008171:Lung Diseases / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011786:Quality Control; D012141:Respiratory Tract Infections / Q000150:complications; D018570:Risk Assessment; D012307:Risk Factors; D018401:Sample Size