3 Key Takeaways
Plain English Summary- 01Core Finding
However, absence of standardised definitions and heterogeneity in component selection limit comparability across studies and might bias estimates of treatment effects.
- 02Study Evidence
Tested in a observational cohort study at the real-world cohort stage.
- 03Practical Meaning
Observational cohort findings reveal real-world links, though lifestyle or unmeasured factors cannot be fully ruled out without an RCT.
What This Means for You
Panellists supported the use of routinely collected clinical data and a standardised in-hospital monitoring approach but did not reach consensus on the optimal follow-up period or need for post-discharge surveillance. Severity-based rank ordering enabled hierarchical organisation of PPC components according to their clinical importance, supporting the development of ordinal composite outcomes that account for differences in severity between individual complications. This international consensus-based framework provides a standardised definition of PPCs incorporating severity-based rank ordering, addresses important limitations of existing composite outcomes, and might facilitate more consistent and clinically meaningful evaluation of perioperative interventions. Further work should focus on external validation, implementation in clinical trial analyses, and assessment of applicability across diverse patient populations and health-care settings.
The Discovery
Postoperative pulmonary complications (PPCs) are common after surgery and contribute substantially to morbidity, mortality, and health-care burden, and are frequently used as endpoints in clinical studies. However, absence of standardised definitions and heterogeneity in component selection limit comparability across studies and might bias estimates of treatment effects. The Postoperative Pulmonary Complications-Evaluation for Consensus on Standardised Outcomes (PrECiSIOn) study was an international, mixed-method consensus study using a Delphi process to establish a standardised definition of PPCs, determine severity-based ranking of individual components, and define approaches for their assessment. A multidisciplinary panel of experts in PPCs was recruited and candidate PPC components were identified through a focused literature review, structured into domains, and evaluated across iterative Delphi rounds using a seven-point Likert scale, with consensus predefined as ≥75% agreement. Patient and patient care representative perspectives were incorporated through interviews and surveys, and panellists assigned severity weights to components reaching consensus. Input from 44 panellists and five patients and patient representatives informed the prioritisation of clinically meaningful outcomes. Consensus was achieved on a standardised PPC construct comprising components grouped into four domains: symptoms, diagnoses, therapies, and outcomes.
How It Works, Simply
This pulmonology research focuses on airway remodeling & alveolar gas-exchange pathway. Researchers evaluated it using an observational cohort study at the real-world cohort stage of medical research.
3 Key Takeaways
Clinical Takeaways- 01Core Finding
However, absence of standardised definitions and heterogeneity in component selection limit comparability across studies and might bias estimates of treatment effects.
- 02Study Evidence
Tested in a observational cohort study at the real-world cohort stage.
- 03Practical Meaning
Observational cohort findings reveal real-world links, though lifestyle or unmeasured factors cannot be fully ruled out without an RCT.
Biological Mechanism & Study Design
Study Design & Cohort
Observational cohort study
Observational cohort study · Real-World Cohort
Biological Pathway & Modality
Airway remodeling & alveolar gas-exchange pathway
Intervention: Consensus on the definition, components, and grading of composite postoperative
Experimental Findings & Endpoints
Postoperative pulmonary complications (PPCs) are common after surgery and contribute substantially to morbidity, mortality, and health-care burden, and are frequently used as endpoints in clinical studies.
However, absence of standardised definitions and heterogeneity in component selection limit comparability across studies and might bias estimates of treatment effects. The Postoperative Pulmonary Complications-Evaluation for Consensus on Standardised Outcomes (PrECiSIOn) study was an international, mixed-method consensus study using a Delphi process to establish a standardised definition of PPCs, determine severity-based ranking of individual components, and define approaches for their assessment.
A multidisciplinary panel of experts in PPCs was recruited and candidate PPC components were identified through a focused literature review, structured into domains, and evaluated across iterative Delphi rounds using a seven-point Likert scale, with consensus predefined as ≥75% agreement. Patient and patient care representative perspectives were incorporated through interviews and surveys, and panellists assigned severity weights to components reaching consensus.
Input from 44 panellists and five patients and patient representatives informed the prioritisation of clinically meaningful outcomes. Consensus was achieved on a standardised PPC construct comprising components grouped into four domains: symptoms, diagnoses, therapies, and outcomes.
Clinical Translation & Practice Context
Panellists supported the use of routinely collected clinical data and a standardised in-hospital monitoring approach but did not reach consensus on the optimal follow-up period or need for post-discharge surveillance.
Severity-based rank ordering enabled hierarchical organisation of PPC components according to their clinical importance, supporting the development of ordinal composite outcomes that account for differences in severity between individual complications. This international consensus-based framework provides a standardised definition of PPCs incorporating severity-based rank ordering, addresses important limitations of existing composite outcomes, and might facilitate more consistent and clinically meaningful evaluation of perioperative interventions.
Further work should focus on external validation, implementation in clinical trial analyses, and assessment of applicability across diverse patient populations and health-care settings.
The Bottom Line · Clinical Pearl
“Further work should focus on external validation, implementation in clinical trial analyses, and assessment of applicability across diverse patient populations and health-care settings.”
Published in The Lancet Respiratory Medicine · Current Stage: Real-World Cohort