Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

Background Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. Methods We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). Findings In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683–0·717]). Interpretation In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. Funding British Journal of Surgery Society

The Role of Sociocultural Influences on Symptoms of Muscle Dysmorphia and Eating Disorders in Men, and the Mediating Effects of Perfectionism

This study examined the mediating role of self-oriented and socially prescribed perfectionism in the relationship between sociocultural influences (i.e., media, peer, and teasing) and symptoms of muscle dysmorphia (MD) and eating disorders (ED). A nonclinical sample of males (N = 158, Mage = 26.94, SD = 5.50) completed measures of perfectionism, MD, body dissatisfaction, drive for thinness, and bulimia. Susceptibility to appearance-based messages from the media, their peers, and family was also measured. Analyses confirmed the partial mediating role of self-oriented perfectionism only for drive for thinness. In contrast, socially prescribed perfectionism was found to be a partial mediator between all three sociocultural variables and measures of both MD and ED; except for those between peer influence and body dissatisfaction, and teasing and bulimia symptomatology. These two relationships were fully mediated by socially prescribed perfectionism. Results suggest that vulnerability to MD and ED depend on pre-existing perfectionistic attitudes, particularly that of socially prescribed perfectionism