{
  "abstract": "Introduction Postoperative pulmonary complications (PPCs) represent a significant cause of postoperative morbidity and even mortality. However, there is a lack of consensus regarding this composite endpoint, the definition of the individual components, classification and optimal outcome measures. This study aims to refine the PPCs composite framework by evaluating its construct validity, assessing the necessity and risks of a composite measure and exploring the feasibility of differentiating severity categories.Methods A Delphi consensus process will be conducted, engaging an international multidisciplinary group of 30–40 panellists, including clinicians, researchers, patients, public representatives and health economists. Through iterative rounds, the study will seek agreement on the individual components of the PPCs composite. Additionally, consensus will establish a framework for a composite outcome measure based on a standardised severity classification, appropriate timeframes and weighted grading of PPCs.Analysis Consensus, defined by ≥75% concurrence in multiple choice questions or on Likert–scale statements, will be evaluated from round 2 onwards. Delphi rounds will be continued until all statements have reached stability of responses evaluated by χ 2 tests or the Kruskal-Wallis test.Ethics and dissemination The study will be conducted in strict compliance with the principles of the Declaration of Helsinki and will adhere to ACCORD guidance for reporting. Ethics approval has been obtained for this study from the University of Wolverhampton, UK (SOABE/202425/staff/3). Informed consent will be obtained from all panellists before the commencement of the Delphi process. The results of the study will be published in a peer–reviewed journal with the authorship assigned in accordance with ICMJE requirements.Trial registration number NCT06916598 (clinicaltrials.gov).",
  "authors": [
    {
      "affiliations": [
        "Department of Intensive Care, Amsterdam UMC, location 'AMC', Amsterdam, The Netherlands",
        "Department of Critical Care Medicine and Anaesthesia, The Royal Wolverhampton NHS Trust, New Cross Hospital, Wolverhampton, UK"
      ],
      "name": "Prashant Nasa"
    },
    {
      "affiliations": [
        "Division of Anesthesiology, Rescue and Pain Medicine, HOCH Health Ostschweiz, St. Gallen, Switzerland"
      ],
      "name": "Timur Yurttas"
    },
    {
      "affiliations": [
        "Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genoa, Italy",
        "Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy"
      ],
      "name": "Denise Battaglini"
    },
    {
      "affiliations": [
        "Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium"
      ],
      "name": "Stijn Blot"
    },
    {
      "affiliations": [
        "Department of Anesthesiology, University of Colorado System, Denver, Colorado, USA"
      ],
      "name": "Ana Fernandez-Bustamante"
    },
    {
      "affiliations": [
        "Departments of Intensive Care and Resuscitation and Outcomes ResearchDepartment of Cardiothoracic Anaesthesiology, Cleveland Clinic, Cleveland, Ohio, USA",
        "Pulmonary Engineering Group, Department of Anaesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany"
      ],
      "name": "Marcelo Gama de Abreu"
    },
    {
      "affiliations": [
        "Department of Intensive Care, Amsterdam UMC, location 'AMC', Amsterdam, The Netherlands",
        "Department of Anaesthesiology, Amsterdam University Medical Centres, Amsterdam, The Netherlands"
      ],
      "name": "David M van Meenen"
    },
    {
      "affiliations": [
        "Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India"
      ],
      "name": "Sheila Nainan Myatra"
    },
    {
      "affiliations": [
        "Department of Intensive Care, Amsterdam UMC, location 'AMC', Amsterdam, The Netherlands",
        "Australian and New Zealand Intensive Care–Research Centre (ANZIC–RC), Monash University, Melbourne, Victoria, Australia",
        "Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia",
        "Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil"
      ],
      "name": "Ary Serpa Neto"
    },
    {
      "affiliations": [
        "Health Economics Unit, Department of Applied Health Sciences, College of Medicine and Health, University of Birmingham, Birmingham, UK"
      ],
      "name": "Raymond Oppong"
    },
    {
      "affiliations": [
        "Department of Intensive Care, Amsterdam UMC, location 'AMC', Amsterdam, The Netherlands"
      ],
      "name": "Frederique Paulus"
    },
    {
      "affiliations": [
        "Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton, UK"
      ],
      "name": "Suresh Renukappa"
    },
    {
      "affiliations": [
        "Department of Intensive Care, Amsterdam UMC, location 'AMC', Amsterdam, The Netherlands",
        "Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand",
        "Nuffield Department of Medicine, University of Oxford, Oxford, UK",
        "Department of Anaesthesia, General Intensive Care and Pain Management, Division of Cardiothoracic and Vascular Anaesthesia and Critical Care Medicine, Medical University of Vienna, Vienna, Austria"
      ],
      "name": "Marcus J Schultz"
    },
    {
      "affiliations": [
        "Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada",
        "Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada"
      ],
      "name": "Arthur S Slutsky"
    },
    {
      "affiliations": [
        "Department of Intensive Care, Amsterdam UMC, location 'AMC', Amsterdam, The Netherlands",
        "Department of Anaesthesiology, The Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands"
      ],
      "name": "Sabrine N T Hemmes"
    },
    {
      "affiliations": [],
      "name": "for the PrECiSIOn–group"
    }
  ],
  "title": "Consensus on the definition, components, timeframe and grading of composite outcome of postoperative pulmonary complication—protocol for an international mixed-method consensus study (PrECiSIOn)",
  "uid": "2408d65e-1029-5c96-a3e2-b1315d074585"
}