{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,12]],"date-time":"2026-11-12T18:27:28Z","timestamp":1794508048795,"version":"4.9.1"},"reference-count":22,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T00:00:00Z","timestamp":1755561600000},"content-version":"unspecified","delay-in-days":18,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,7,18]]},"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A Delphi consensus process will be conducted, engaging an international multidisciplinary group of 30\u201340 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Analysis<\/jats:title>\n                    <jats:p>\n                      Consensus, defined by \u226575% concurrence in multiple choice questions or on Likert\u2013scale statements, will be evaluated from round 2 onwards. Delphi rounds will be continued until all statements have reached stability of responses evaluated by \u03c7\n                      <jats:sup>2<\/jats:sup>\n                      tests or the Kruskal-Wallis test.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>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\u2013reviewed journal with the authorship assigned in accordance with ICMJE requirements.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT06916598\">NCT06916598<\/jats:ext-link>\n                      (clinicaltrials.gov).\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-103888","type":"journal-article","created":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T15:15:56Z","timestamp":1755616556000},"page":"e103888","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":19,"title":["Consensus on the definition, components, timeframe and grading of composite outcome of postoperative pulmonary complication\u2014protocol for an international mixed-method consensus study (PrECiSIOn)"],"prefix":"10.1136","volume":"15","clinical-trial-number":[{"clinical-trial-number":"nct06916598","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct06916598","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1948-4060","authenticated-orcid":false,"given":"Prashant","family":"Nasa","sequence":"first","affiliation":[{"name":"Department of Intensive Care, Amsterdam UMC, location 'AMC', Amsterdam, The Netherlands"},{"name":"Department of Critical Care Medicine and Anaesthesia, The Royal Wolverhampton NHS Trust, New Cross Hospital, Wolverhampton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timur","family":"Yurttas","sequence":"additional","affiliation":[{"name":"Division of Anesthesiology, Rescue and Pain Medicine, HOCH Health Ostschweiz, St. Gallen, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6895-6442","authenticated-orcid":false,"given":"Denise","family":"Battaglini","sequence":"additional","affiliation":[{"name":"Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genoa, Italy"},{"name":"Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2145-0345","authenticated-orcid":false,"given":"Stijn","family":"Blot","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Fernandez-Bustamante","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, University of Colorado System, Denver, Colorado, 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Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ary","family":"Serpa Neto","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, Amsterdam UMC, location 'AMC', Amsterdam, The Netherlands"},{"name":"Australian and New Zealand Intensive Care\u2013Research Centre (ANZIC\u2013RC), Monash University, Melbourne, Victoria, Australia"},{"name":"Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia"},{"name":"Department of Critical Care Medicine, Hospital Israelita Albert Einstein, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0815-4616","authenticated-orcid":false,"given":"Raymond","family":"Oppong","sequence":"additional","affiliation":[{"name":"Health Economics Unit, Department of Applied Health Sciences, College of Medicine and 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