The DOI matches its Crossref record; 33 of the 33 references it cites were found in a registry or an index; none of the 55 sources its claims cite is checked for support yet.
Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery: A Multicenter Study by the Perioperative Research Network Investigators
Open accessAbstract
Importance: Postoperative pulmonary complications (PPCs), a leading cause of poor surgical outcomes, are heterogeneous in their pathophysiology, severity, and reporting accuracy. Objective: To prospectively study clinical and radiological PPCs and respiratory insufficiency therapies in a high-risk surgical population. Design, Setting, and Participants: We performed a multicenter prospective observational study in 7 US academic institutions. American Society of Anesthesiologists physical status 3 patients who presented for noncardiothoracic surgery requiring 2 hours or more of general anesthesia with mechanical ventilation from May to November 2014 were included in the study. We hypothesized that PPCs, even mild, would be associated with early postoperative mortality and use of hospital resources. We analyzed their association with modifiable perioperative variables. Exposure: Noncardiothoracic surgery. Main Outcomes and Measures: Predefined PPCs occurring within the first 7 postoperative days were prospectively identified. We used bivariable and logistic regression analyses to study the association of PPCs with ventilatory and other perioperative variables. Results: This study included 1202 patients who underwent predominantly abdominal, orthopedic, and neurological procedures. The mean (SD) age of patients was 62.1 (13.8) years, and 636 (52.9%) were men. At least 1 PPC occurred in 401 patients (33.4%), mainly the need for prolonged oxygen therapy by nasal cannula (n = 235; 19.6%) and atelectasis (n = 206; 17.1%). Patients with 1 or more PPCs, even mild, had significantly increased early postoperative mortality, intensive care unit (ICU) admission, and ICU/hospital length of stay. Significant PPC risk factors included nonmodifiable (emergency [yes vs no]: odds ratio [OR], 4.47, 95% CI, 1.59-12.56; surgical site [abdominal/pelvic vs nonabdominal/pelvic]: OR, 2.54, 95% CI, 1.67-3.89; and age [in years]: OR, 1.03, 95% CI, 1.02-1.05) and potentially modifiable (colloid administration [yes vs no]: OR, 1.75, 95% CI, 1.03-2.97; preoperative oxygenation: OR, 0.86, 95% CI, 0.80-0.93; blood loss [in milliliters]: OR, 1.17, 95% CI, 1.05-1.30; anesthesia duration [in minutes]: OR, 1.14, 95% CI, 1.05-1.24; and tidal volume [in milliliters per kilogram of predicted body weight]: OR, 1.12, 95% CI, 1.01-1.24) factors. Conclusions and Relevance: Postoperative pulmonary complications are common in patients with American Society of Anesthesiologists physical status 3, despite current protective ventilation practices. Even mild PPCs are associated with increased early postoperative mortality, ICU admission, and length of stay (ICU and hospital). Mild frequent PPCs (eg, atelectasis and prolonged oxygen therapy need) deserve increased attention and intervention for improving perioperative outcomes.
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“mainly the need for prolonged oxygen therapy by nasal cannula (n = 235; 19.6%)”
- Also stated in: § Results · plain
“The most frequent PPC was the prolonged (>1 day) need for oxygen supplementation by NC, followed by atelectasis and pleural effusion (Table 2).”
§ Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery > Abstract > RESULTS
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“estimated blood loss (OR, 1.17; 95% CI, 1.05–1.30)”
§ Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery > Results
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“abdominal/pelvic surgery (OR, 2.54; 95% CI, 1.67–3.89)”
§ Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery > Results
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In the paper
“anesthesia duration (OR, 1.14; 95% CI, 1.05–1.24)”
§ Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery > Results
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“emergency (OR, 4.47; 95% CI, 1.59–12.56)”
§ Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery > Results
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In the paper
“and atelectasis (n = 206; 17.1%)”
§ Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery > Abstract > RESULTS
Strength:plain· not yet calibratedn = 206Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“VT (milliliters per kilogram of predicted body weight) (OR, 1.12; 95% CI, 1.01–1.24)”
§ Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery > Results
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“At least 1 PPC occurred in 401 patients (33.4%)”
- Also stated in: § Results · plain
“A third of the studied patients (n = 401) developed at least 1 PPC (Table 2).”
§ Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery > Abstract > RESULTS
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In the paper
“While most patients presented a single PPC, 14% of patients experienced 2 or more PPCs (Table 3).”
§ Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery > Results
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In the paper
“colloid use (OR, 1.75; 95% CI, 1.03–2.97)”
§ Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery > Results
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- It may state two separate claims as one. 23
- Probably not a substantial claim. 18
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In the paper
“but it was also significantly associated with pneumonia, pleural effusion, and atelectasis (observed rates of 9.1%, 7.0%, and 4.4%, respectively, and RRs of 15.3 [95% CI, 3.4–69.4], 75.3 [95% CI, 9.5–597.0], and undefined, respectively)”
§ Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery > Results
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In the paper
“Early mortality rate was the highest in patients with ARDS and reintubation with POMV (50% and 14.3%, respectively, corresponding to relative risks [RR] of 74.8 [95% CI, 15.9–351.6] and 28.0 [95% CI, 7.5–104.6], respectively)”
§ Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery > Results
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Patients with 1 or more PPCs, even mild, had significantly increased early postoperative mortality, intensive care unit (ICU) admission, and ICU/hospital length of stay.”
- Also stated in: § Results · plain
“Median hospital LOS increased as the number of PPCs per patient increased.”
§ Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery > Abstract > RESULTS
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- Also stated in: § Results · plain
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In the paper
“Pneumothorax, bronchospasm, and requirement of prolonged use of oxygen by NC/FM were not associated with early mortality.”
§ Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery > Results
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In the paper
“Nine patients (0.8%) died within the first 7 PODs (early postoperative mortality), all with more than 1 pulmonary complication (Table 3).”
§ Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery > Results
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
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In the paper
“Importantly, less severe but considerably more frequent PPCs, such as atelectasis or pleural effusion, also increased the risk for mortality (RR calculated as undefined high owing to denominator equal to 0 or 75.3, respectively) and ICU/ hospital LOS (see RRs in Table 4).”
§ Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery > Discussion
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“The most severe PPCs— ARDS and reintubation with POMV—significantly increased the risk for early mortality risk (RRs, 74.8 and 28.0, respectively) and the ICU LOS but they were rare in ours and previous studies (Table 4).10,11”
§ Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery > Discussion
What the sources say
- Not checked yetcites [10]
- Not checked yetcites [11]
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“For example, the presence of pneumothorax, bronchospasm, and oxygen requirement by NC/FM were significantly associated with longer hospital LOS despite no association with mortality.”
§ Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery > Discussion
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Pneumonia could be considered a moderate PPC in both frequency and severity, increasing the risk for mortality (RR, 15.3) and the ICU/hospital LOS (Table 4).”
§ Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery > Discussion
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We performed a multicenter prospective observational study in 7 US academic institutions.”
§ Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery > Abstract > DESIGN, SETTING, AND PARTICIPANTS
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“The estimated sample size of 1000 patients provided 80% power to detect an odds ratio (OR) of 1.2 or greater as statistically significant for each ventilatory variable of interest and its association with the composite outcome of any of the PPCs”
§ Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery > Methods > Statistical Analysis
What the sources say
- Not checked yetcites [2]
Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“For the final model, multivariable hierarchical logistic regression was used to model the relationships between the development of PPC and ventilatory settings.”
§ Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery > Methods > Statistical Analysis
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
None of the sources cited for this claim have been checked yet.
In the paper
“Interventions to reduce PPCs include intraoperative intensive care unit (ICU)–like mechanical ventilation strategies,5,10,12,13 which have been adopted over the past decade by US academic centers.14,15”
§ Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery > Abstract > CONCLUSIONS AND RELEVANCE
What the sources say
- Not checked yetcites [5]
- Not checked yetcites [10]
- Not checked yetcites [12]
- Not checked yetcites [13]
- Not checked yetcites [14]
- Not checked yetcites [15]
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Previous studies on PPCs1,2,6,10,11 have been mostly retrospective10,11 or based on administrative data,1,6 or they included patients at very different risk levels for PPCs.2,11”
§ Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery > Abstract > CONCLUSIONS AND RELEVANCE
What the sources say
- Not checked yetcites [1]
- Not checked yetcites [2]
- Not checked yetcites [6]
- Not checked yetcites [10]
- Not checked yetcites [11]
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Any missing and outlier data values were individually revised for completion or correction or left as missing data points in our study database.”
§ Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery > Methods > Statistical Analysis
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“This surgical population subset is particularly susceptible to PPCs2 and would be an ideal target for future interventions based on their volume and severe, but not life-threatening, disease burden.”
§ Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery > Abstract > CONCLUSIONS AND RELEVANCE
What the sources say
- Not checked yetcites [2]
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Radiological diagnoses were reported by attending radiologists independent of the study, with the final consideration as PPC by local study principal investigators.”
§ Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery > Methods > End Points
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Yet, the contemporary incidence, clinical impact, and risk factors of individual PPCs after these practice changes are unknown.”
§ Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery > Abstract > CONCLUSIONS AND RELEVANCE
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Predefined PPCs occurring within the first 7 postoperative days were prospectively identified.”
§ Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery > Abstract > MAIN OUTCOMES AND MEASURES
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In the paper
“These PPC composite bivariable associations were then individually adjusted by clustering of patients within sites using simple hierarchical logistic regression with site as a random effect.”
§ Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery > Methods > Statistical Analysis
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“This study was developed in a detailoriented manner with preagreement of terms and data to be collected.”
§ Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery > Discussion
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We addressed the residual bias and confounding effects with adjusted analyses.”
§ Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery > Discussion > Limitations
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
- Rests on an assumption: Residual confounding does not explain the observed associations between PPCs and outcomes.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The need for oxygen therapy was determined by local practices and not by the implementation of a common protocol.”
§ Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery > Discussion > Limitations
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
- Rests on an assumption: Local, non-protocolized oxygen therapy practices did not materially bias the association between prolonged oxygen requirement and outcomes.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Our findings reflect statistical associations and do not imply cause-effect relationships.”
§ Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery > Discussion > Limitations
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The prospective enrollment, data collection, and validation add reliability to clinical outcomes that are often more challenging to measure than mortality.”
§ Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery > Discussion
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Radiological examinations were not obtained in all patients and therefore may induce a selection bias.”
§ Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery > Discussion > Limitations
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- Rests on an assumption: Radiological examinations not obtained in all patients did not materially bias the PPC-outcome associations.
None of the sources cited for this claim have been checked yet.
In the paper
“Open and laparoscopic abdominal procedures were combined because the impact on PPCs after varied operations remains unclear.5,23,24”
§ Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery > Discussion
What the sources say
- Not checked yetcites [5]
- Not checked yetcites [23]
- Not checked yetcites [24]
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Our findings underline that not only severe but also mild PPCs are associated with significantly increased morbidity, mortality, and ICU and hospital LOS.”
§ Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery > Discussion
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“The observed incidence of at least 1 PPC in 33.4% of patients was higher than previous reports,2,6–9 likely due to a combination of different patient characteristics, surgical procedures, and PPC definitions.”
§ Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery > Discussion
What the sources say
- Not checked yetcites [2]
- Not checked yetcites [6]
- Not checked yetcites [7]
- Not checked yetcites [8]
- Not checked yetcites [9]
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“There is an increased interest in perioperative protective mechanical ventilation and a trend to use lower intraoperative VTs despite limited information on the specific optimal settings for different surgical patients.5,10,29”
§ Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery > Discussion
What the sources say
- Not checked yetcites [5]
- Not checked yetcites [10]
- Not checked yetcites [29]
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Surgical procedures were classified into abdominal/pelvic and nonabdominal/pelvic following previous PPC risk assessments2,22 reporting the highest risk for PPCs after thoracic procedures (excluded from this study) followed by abdominal surgical procedures, then peripheral procedures (lowest risk).”
§ Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery > Discussion
What the sources say
- Not checked yetcites [2]
- Not checked yetcites [22]
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Indeed, hypoxemia32 has been found to be a common, persistent, and often underdiagnosed postoperative complication.”
§ Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery > Discussion > Limitations
What the sources say
- Not checked yetcites [32]
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Interestingly, recent studies have shown an increased PPC risk in surgical patients with hypoalbuminemia.2,26”
§ Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery > Discussion
What the sources say
- Not checked yetcites [2]
- Not checked yetcites [26]
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This has likely introduced heterogeneity with potential avoidable oxygen therapy but also untreated hypoxemia being present in our sample.”
§ Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery > Discussion > Limitations
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Our study presents several limitations primarily related to its observational nature, preselection of specific PPC definitions, and possible multiple testing.”
§ Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery > Discussion > Limitations
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
The paper relies on this without support.
Residual confounding does not explain the observed associations between PPCs and outcomes.
“We addressed the residual bias and confounding effects with adjusted analyses.”
The paper relies on this without support.
Local, non-protocolized oxygen therapy practices did not materially bias the association between prolonged oxygen requirement and outcomes.
“The need for oxygen therapy was determined by local practices and not by the implementation of a common protocol.”
The paper relies on this without support.
Radiological examinations not obtained in all patients did not materially bias the PPC-outcome associations.
“Radiological examinations were not obtained in all patients and therefore may induce a selection bias.”
Citations
Cites
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Metadata
- Authors
- Fernandez-Bustamante, A., Frendl, G., Sprung, J., Kor, D. J., Subramaniam, B., Martinez Ruiz, R., Lee, J.-W., Henderson, W. G., Moss, A., Mehdiratta, N., Colwell, M. M., Bartels, K., Kolodzie, K., Giquel, J., & Vidal Melo, M. F.
- Affiliations
- University of Colorado Anschutz (US)
- Brigham and Women’s Hospital, Boston, Massachusetts
- Mayo Clinic College of Medicine, Rochester, Minnesota
- Mayo Clinic (US)
- Beth Israel Deaconess Medical Center (US)
- University of Miami, Palmetto Bay, Florida
- University of California, San Francisco (US)
- Brigham and Women's Hospital (US)
- Massachusetts General Hospital (US)
- University of Miami (US)
- Massachusetts General Hospital, Boston
- Corresponding author
- Fernandez-Bustamante, Ana
- ORCID
- Venue
- JAMA Surgery
- Publisher
- American Medical Association (AMA)
- Published
- 2017-02-01
- Volume
- 152
- Issue
- 2
- Pages
- 157
- ISSN
- 2168-6254 (ISSN-L)
- PMC
- PMC5334462
- OpenAlex
- W2552081789
- Cited by
- 653
- References
- 33
- Citations by year
- 2026: 88 · 2025: 89 · 2024: 103 · 2023: 76 · 2022: 87 · 2021: 67 · 2020: 76 · 2019: 36 · 2018: 18 · 2017: 11
- FWCI
- 17.84
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- JAMA Surgery (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (R34HL123438, K23HL112855)
- National Institute on Drug Abuse (K23DA040923)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Keywords
- postoperative pulmonary complications, early postoperative mortality, length of hospital stay, atelectasis, oxygen therapy, respiratory failure, mechanical ventilation, colloid administration, emergency surgery, abdominal surgery, intensive care unit admission, risk factors, general anesthesia, high-risk surgical patients, perioperative care
- MeSH terms
- Abdomen, Age Factors, Aged, Aged, 80 and over, Anesthesia, Colloids, Emergencies, Female, Humans, Intensive Care Units, Length of Stay, Lung Diseases, Male, Middle Aged, Oxygen Inhalation Therapy, Pelvis, Postoperative Complications, Preoperative Care, Prospective Studies, Respiration, Artificial, Respiratory Insufficiency, Risk Factors, Tidal Volume, Time Factors, Blood Loss, Surgical, Neurosurgical Procedures, Orthopedic Procedures
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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