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BackgroundCurrently 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.ObjectiveWe aimed to develop a new prediction score for PPCs that uses both pre-operative and intra-operative data.DesignThis is a secondary analysis of the LAS VEGAS study, a large international, multicentre, prospective study.SettingsA total of 146 hospitals across 29 countries.PatientsAdult patients requiring intra-operative ventilation during general anaesthesia for surgery.InterventionsThe cohort was randomly divided into a development subsample to construct a predictive model, and a subsample for validation.Main outcome measuresPrediction performance of developed models for PPCs.ResultsOf 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.ConclusionThe 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 registrationThe study was registered at, number NCT01601223.

Original publication




Journal article


European journal of anaesthesiology

Publication Date





691 - 701


From the Hospital Israelita Albert Einstein, São Paulo, Brazil (ASN, LGVC), Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands (SNTH), Hospital Universitari Germans Trias I Pujol, Barcelona, Spain (JC), University Hospital Uppsula, Uppsala, Sweden (GH), Saint Eloi University Hospital, Montpellier, France (SJ), Medical University Vienna, Vienna, Austria (MH,WS), Academic Medical Center, Amsterdam, the Netherlands (MWH, MJS), Sheffield Teaching Hospitals, Sheffield, UK (GHM), Massachusetts General Hospital, Boston, USA (MFVM), Queen Mary University of London, London, UK (RP), University Hospital Bonn, Bonn, Germany (CP), University of Insubria, Varese, Italy (PS), University of Leipzig, Leipzig, Germany (HW), University Hospital Dresden, Dresden, Germany (MGA), Ospedale Policlinico San Martino - IRCCS per l'Oncologia, University of Genoa, Genoa, Italy (PP).


LAS VEGAS, Lung, Humans, Lung Diseases, Postoperative Complications, Intraoperative Period, Risk Factors, Cohort Studies, Prospective Studies, Reproducibility of Results, Predictive Value of Tests, Age Factors, Health Status, Middle Aged, Female, Male, Preoperative Period, Operative Time