Abstract Introduction Postoperative pulmonary complications (PPCs) following major abdominal surgery result in substantial morbidity and mortality, yet stratifying patients for risk-modifying interventions remains challenging. This study aimed to systematically review and externally validate existing PPC risk prediction models in an international, prospective cohort. Method A systematic search of the MEDLINE and EMBASE databases according to PRISMA guidelines was performed to identify original risk prediction models for PPC following abdominal surgery. Subsequent external validation was performed based on a prospective dataset (REspiratory COmplications after abdomiNal surgery) which encompassed adult patients undergoing major abdominal surgery from January to April 2019 across the UK, Ireland and Australia. The primary outcome was 30-day PPC (StEP-COMPAC criteria definition), and multivariable logistic regression model discrimination were compared (with an area under the curve (AUC) ≥0.7 considered “good”). Result
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