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Br J Anaesth. 2018 May;120(5):1066-1079. doi: 10.1016/j.bja.2018.02.007. Epub 2018 Mar 27.

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

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Queen Mary University of London, London, UK; Department of Anaesthesia and Critical Care, University College London Hospital, London, UK.
Queen Mary University of London, London, UK.
Department of Surgical Sciences and Integrated Diagnostics, San Martino Policlinico Hospital, IRCCS for Oncology, University of Genoa, Genoa, Italy.
Department of Anesthesiology and Intensive Care Therapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
Department of Anaesthesiology and Intensive Care Medicine, Herlev University Hospital, Herlev, Denmark.
Department of Anaesthesiology, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain.
Intensive Care Unit, Royal Surrey County Hospital, Guildford, UK; Surrey Perioperative Anaesthesia Critical Care Collaborative Research Group (SPACeR), Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.
Department of Anaesthesia and Critical Care, University College London Hospital, London, UK.
Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, China.
Department of Anesthesiology and Pain Medicine, Ottawa Hospital, University of Ottawa, Clinical Epidemiology and Regenerative Medicine Programs, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Department of Perioperative Medicine, Anaesthesiology and Critical Care, Estaing Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.
Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK; Critical Care Research Group, Southampton NIHR Biomedical Research Centre, University Hospital Southampton, Southampton, UK.
Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands; Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand.
Queen Mary University of London, London, UK. Electronic address:



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.


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.


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.


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

[Indexed for MEDLINE]

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