A systematic review and consensus definitions for standardised end-points in perioperative medicine

pulmonary complications

T. E.F. Abbott, A. J. Fowler, P. Pelosi, M. Gama de Abreu, A. M. Møller, J. Canet, B. Creagh-Brown, M. Mythen, T. Gin, M. M. Lalu, E. Futier, M. P. Grocott, M. J. Schultz, R. M. Pearse, the StEP-COMPAC Group

Research output: Contribution to journalReview ArticleResearchpeer-review

Abstract

Background: There is a need for robust, clearly defined, patient-relevant outcome measures for use in randomised trials in perioperative medicine. Our objective was to establish standard outcome measures for postoperative pulmonary complications research. Methods: A systematic literature search was conducted using MEDLINE, Web of Science, SciELO, and the Korean Journal Database. Definitions were extracted from included manuscripts. We then conducted a three-stage Delphi consensus process to select the optimal outcome measures in terms of methodological quality and overall suitability for perioperative trials. Results: From 2358 records, the full texts of 81 manuscripts were retrieved, of which 45 met the inclusion criteria. We identified three main categories of outcome measure specific to perioperative pulmonary outcomes: (i) composite outcome measures of multiple pulmonary outcomes (27 definitions); (ii) pneumonia (12 definitions); and (iii) respiratory failure (six definitions). These were rated by the group according to suitability for routine use. The majority of definitions were given a low score, and many were imprecise, difficult to apply consistently, or both, in large patient populations. A small number of highly rated definitions were identified as appropriate for widespread use. The group then recommended four outcome measures for future use, including one new definition. Conclusions: A large number of postoperative pulmonary outcome measures have been used, but most are poorly defined. Our four recommended outcome measures include a new definition of postoperative pulmonary complications, incorporating an assessment of severity. These definitions will meet the needs of most clinical effectiveness trials of treatments to improve postoperative pulmonary outcomes.

Original languageEnglish
Pages (from-to)1066-1079
Number of pages14
JournalBritish Journal of Anaesthesia
Volume120
Issue number5
DOIs
Publication statusPublished - 1 May 2018

Keywords

  • outcome assessment (healthcare)/standards
  • perioperative care/methods

Cite this

Abbott, T. E. F., Fowler, A. J., Pelosi, P., Gama de Abreu, M., Møller, A. M., Canet, J., ... the StEP-COMPAC Group (2018). A systematic review and consensus definitions for standardised end-points in perioperative medicine: pulmonary complications. British Journal of Anaesthesia, 120(5), 1066-1079. https://doi.org/10.1016/j.bja.2018.02.007
Abbott, T. E.F. ; Fowler, A. J. ; Pelosi, P. ; Gama de Abreu, M. ; Møller, A. M. ; Canet, J. ; Creagh-Brown, B. ; Mythen, M. ; Gin, T. ; Lalu, M. M. ; Futier, E. ; Grocott, M. P. ; Schultz, M. J. ; Pearse, R. M. ; the StEP-COMPAC Group. / A systematic review and consensus definitions for standardised end-points in perioperative medicine : pulmonary complications. In: British Journal of Anaesthesia. 2018 ; Vol. 120, No. 5. pp. 1066-1079.
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title = "A systematic review and consensus definitions for standardised end-points in perioperative medicine: pulmonary complications",
abstract = "Background: There is a need for robust, clearly defined, patient-relevant outcome measures for use in randomised trials in perioperative medicine. Our objective was to establish standard outcome measures for postoperative pulmonary complications research. Methods: A systematic literature search was conducted using MEDLINE, Web of Science, SciELO, and the Korean Journal Database. Definitions were extracted from included manuscripts. We then conducted a three-stage Delphi consensus process to select the optimal outcome measures in terms of methodological quality and overall suitability for perioperative trials. Results: From 2358 records, the full texts of 81 manuscripts were retrieved, of which 45 met the inclusion criteria. We identified three main categories of outcome measure specific to perioperative pulmonary outcomes: (i) composite outcome measures of multiple pulmonary outcomes (27 definitions); (ii) pneumonia (12 definitions); and (iii) respiratory failure (six definitions). These were rated by the group according to suitability for routine use. The majority of definitions were given a low score, and many were imprecise, difficult to apply consistently, or both, in large patient populations. A small number of highly rated definitions were identified as appropriate for widespread use. The group then recommended four outcome measures for future use, including one new definition. Conclusions: A large number of postoperative pulmonary outcome measures have been used, but most are poorly defined. Our four recommended outcome measures include a new definition of postoperative pulmonary complications, incorporating an assessment of severity. These definitions will meet the needs of most clinical effectiveness trials of treatments to improve postoperative pulmonary outcomes.",
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author = "Abbott, {T. E.F.} and Fowler, {A. J.} and P. Pelosi and {Gama de Abreu}, M. and M{\o}ller, {A. M.} and J. Canet and B. Creagh-Brown and M. Mythen and T. Gin and Lalu, {M. M.} and E. Futier and Grocott, {M. P.} and Schultz, {M. J.} and Pearse, {R. M.} and {the StEP-COMPAC Group} and P. Myles and G. Haller and R. Gruen and A. Klein and T. Corcoran and D. McIlroy and R. Bellomo and M. Shulman",
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Abbott, TEF, Fowler, AJ, Pelosi, P, Gama de Abreu, M, Møller, AM, Canet, J, Creagh-Brown, B, Mythen, M, Gin, T, Lalu, MM, Futier, E, Grocott, MP, Schultz, MJ, Pearse, RM & the StEP-COMPAC Group 2018, 'A systematic review and consensus definitions for standardised end-points in perioperative medicine: pulmonary complications', British Journal of Anaesthesia, vol. 120, no. 5, pp. 1066-1079. https://doi.org/10.1016/j.bja.2018.02.007

A systematic review and consensus definitions for standardised end-points in perioperative medicine : pulmonary complications. / Abbott, T. E.F.; Fowler, A. J.; Pelosi, P.; Gama de Abreu, M.; Møller, A. M.; Canet, J.; Creagh-Brown, B.; Mythen, M.; Gin, T.; Lalu, M. M.; Futier, E.; Grocott, M. P.; Schultz, M. J.; Pearse, R. M.; the StEP-COMPAC Group.

In: British Journal of Anaesthesia, Vol. 120, No. 5, 01.05.2018, p. 1066-1079.

Research output: Contribution to journalReview ArticleResearchpeer-review

TY - JOUR

T1 - A systematic review and consensus definitions for standardised end-points in perioperative medicine

T2 - pulmonary complications

AU - Abbott, T. E.F.

AU - Fowler, A. J.

AU - Pelosi, P.

AU - Gama de Abreu, M.

AU - Møller, A. M.

AU - Canet, J.

AU - Creagh-Brown, B.

AU - Mythen, M.

AU - Gin, T.

AU - Lalu, M. M.

AU - Futier, E.

AU - Grocott, M. P.

AU - Schultz, M. J.

AU - Pearse, R. M.

AU - the StEP-COMPAC Group

AU - Myles, P.

AU - Haller, G.

AU - Gruen, R.

AU - Klein, A.

AU - Corcoran, T.

AU - McIlroy, D.

AU - Bellomo, R.

AU - Shulman, M.

PY - 2018/5/1

Y1 - 2018/5/1

N2 - Background: There is a need for robust, clearly defined, patient-relevant outcome measures for use in randomised trials in perioperative medicine. Our objective was to establish standard outcome measures for postoperative pulmonary complications research. Methods: A systematic literature search was conducted using MEDLINE, Web of Science, SciELO, and the Korean Journal Database. Definitions were extracted from included manuscripts. We then conducted a three-stage Delphi consensus process to select the optimal outcome measures in terms of methodological quality and overall suitability for perioperative trials. Results: From 2358 records, the full texts of 81 manuscripts were retrieved, of which 45 met the inclusion criteria. We identified three main categories of outcome measure specific to perioperative pulmonary outcomes: (i) composite outcome measures of multiple pulmonary outcomes (27 definitions); (ii) pneumonia (12 definitions); and (iii) respiratory failure (six definitions). These were rated by the group according to suitability for routine use. The majority of definitions were given a low score, and many were imprecise, difficult to apply consistently, or both, in large patient populations. A small number of highly rated definitions were identified as appropriate for widespread use. The group then recommended four outcome measures for future use, including one new definition. Conclusions: A large number of postoperative pulmonary outcome measures have been used, but most are poorly defined. Our four recommended outcome measures include a new definition of postoperative pulmonary complications, incorporating an assessment of severity. These definitions will meet the needs of most clinical effectiveness trials of treatments to improve postoperative pulmonary outcomes.

AB - Background: There is a need for robust, clearly defined, patient-relevant outcome measures for use in randomised trials in perioperative medicine. Our objective was to establish standard outcome measures for postoperative pulmonary complications research. Methods: A systematic literature search was conducted using MEDLINE, Web of Science, SciELO, and the Korean Journal Database. Definitions were extracted from included manuscripts. We then conducted a three-stage Delphi consensus process to select the optimal outcome measures in terms of methodological quality and overall suitability for perioperative trials. Results: From 2358 records, the full texts of 81 manuscripts were retrieved, of which 45 met the inclusion criteria. We identified three main categories of outcome measure specific to perioperative pulmonary outcomes: (i) composite outcome measures of multiple pulmonary outcomes (27 definitions); (ii) pneumonia (12 definitions); and (iii) respiratory failure (six definitions). These were rated by the group according to suitability for routine use. The majority of definitions were given a low score, and many were imprecise, difficult to apply consistently, or both, in large patient populations. A small number of highly rated definitions were identified as appropriate for widespread use. The group then recommended four outcome measures for future use, including one new definition. Conclusions: A large number of postoperative pulmonary outcome measures have been used, but most are poorly defined. Our four recommended outcome measures include a new definition of postoperative pulmonary complications, incorporating an assessment of severity. These definitions will meet the needs of most clinical effectiveness trials of treatments to improve postoperative pulmonary outcomes.

KW - outcome assessment (healthcare)/standards

KW - perioperative care/methods

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U2 - 10.1016/j.bja.2018.02.007

DO - 10.1016/j.bja.2018.02.007

M3 - Review Article

VL - 120

SP - 1066

EP - 1079

JO - British Journal of Anaesthesia

JF - British Journal of Anaesthesia

SN - 0007-0912

IS - 5

ER -