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

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

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.

outcome assessment (healthcare)/standards, perioperative care/methods
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1066-1079
Abbott, T.E.F.
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Story, D.
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Gruen, R.
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Scott, D.
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van Dijk, D.
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Eriksson, L.
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Beattie, S.
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Wijeysundera, D.
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Landoni, G.
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Leslie, K.
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Biccard, B.
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Howell, S.
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the StEP-COMPAC Group
Abbott, T.E.F.
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Fowler, A.J.
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Mythen, M.
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Pearse, R.M.
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Myles, P.
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Kurz, A.
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Tramèr, M.
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Cyna, A.
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Botti, M.
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Boney, O.
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Haller, G.
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Cook, T.
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Fleisher, L.
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Neuman, M.
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Story, D.
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van Dijk, D.
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Grocott, H.
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Eckenhoff, R.
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Eriksson, L.
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Beattie, S.
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Wijeysundera, D.
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Landoni, G.
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Biccard, B.
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Howell, S.
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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., Myles, P., Gan, T. J., Kurz, A., Peyton, P., Sessler, D., Tramèr, M., Cyna, A., De Oliveira, G. S., Wu, C., Jensen, M., Kehlet, H., Botti, M., Boney, O., Haller, G., Cook, T., Fleisher, L., Neuman, M., Story, D., Gruen, R., Bampoe, S., Evered, Lis, Scott, D., Silbert, B., van Dijk, D., Kalkman, C., Chan, M., Grocott, H., Eckenhoff, R., Rasmussen, L., Eriksson, L., Beattie, S., Wijeysundera, D., Landoni, G., Leslie, K., Biccard, B. and Howell, S. , 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. (doi:10.1016/j.bja.2018.02.007).

Record type: 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.

Text
Pearse BJA 2018 StEP Pulmonary SR and Consensus - Accepted Manuscript
Restricted to Repository staff only until 27 March 2019.
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More information

Accepted/In Press date: 12 February 2018
e-pub ahead of print date: 27 March 2018
Published date: 1 May 2018
Keywords: outcome assessment (healthcare)/standards, perioperative care/methods

Identifiers

Local EPrints ID: 420500
URI: https://eprints.soton.ac.uk/id/eprint/420500
ISSN: 0007-0912
PURE UUID: 4246c7f1-d9a5-411a-b542-c1eb4188a938

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Date deposited: 09 May 2018 16:30
Last modified: 13 Mar 2019 18:33

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Contributors

Author: T.E.F. Abbott
Author: A.J. Fowler
Author: P. Pelosi
Author: M. Gama de Abreu
Author: A.M. Møller
Author: J. Canet
Author: B. Creagh-Brown
Author: M. Mythen
Author: T. Gin
Author: M.M. Lalu
Author: E. Futier
Author: M.P. Grocott
Author: M.J. Schultz
Author: R.M. Pearse
Author: P. Myles
Author: T. J. Gan
Author: A. Kurz
Author: P. Peyton
Author: D. Sessler
Author: M. Tramèr
Author: A. Cyna
Author: G. S. De Oliveira
Author: C. Wu
Author: M. Jensen
Author: H. Kehlet
Author: M. Botti
Author: O. Boney
Author: G. Haller
Author: T. Cook
Author: L. Fleisher
Author: M. Neuman
Author: D. Story
Author: R. Gruen
Author: S. Bampoe
Author: Lis Evered
Author: D. Scott
Author: B. Silbert
Author: D. van Dijk
Author: C. Kalkman
Author: M. Chan
Author: H. Grocott
Author: R. Eckenhoff
Author: L. Rasmussen
Author: L. Eriksson
Author: S. Beattie
Author: D. Wijeysundera
Author: G. Landoni
Author: K. Leslie
Author: B. Biccard
Author: S. Howell

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