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The Association of Intraoperative driving pressure with postoperative pulmonary complications in open versus closed abdominal surgery patients – a posthoc propensity score–weighted cohort analysis of the LAS VEGAS study

Authors
  • Mazzinari, Guido1, 2
  • Serpa Neto, Ary3, 4, 5
  • Hemmes, Sabrine N. T.5
  • Hedenstierna, Goran6
  • Jaber, Samir7
  • Hiesmayr, Michael8
  • Hollmann, Markus W.5
  • Mills, Gary H.9
  • Vidal Melo, Marcos F.10
  • Pearse, Rupert M.11
  • Putensen, Christian12
  • Schmid, Werner8
  • Severgnini, Paolo13
  • Wrigge, Hermann14
  • Cambronero, Oscar Diaz1, 2
  • Ball, Lorenzo15, 16
  • de Abreu, Marcelo Gama17
  • Pelosi, Paolo15, 16
  • Schultz, Marcus J.5, 18, 19
  • Kroell, Wolfgang
  • And 488 more
  • 1 Hospital Universitario y Politécnico la Fe, Avinguda de Fernando Abril Martorell 106, Valencia, 46026, Spain , Valencia (Spain)
  • 2 Hospital Universitario y Politécnico la Fe, Valencia, Spain , Valencia (Spain)
  • 3 Hospital Israelita Albert Einstein, São Paulo, Brazil , São Paulo (Brazil)
  • 4 Instituto do Coração, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil , Sao Paulo (Brazil)
  • 5 Academic Medical Center, Amsterdam, The Netherlands , Amsterdam (Netherlands)
  • 6 Uppsala University, Uppsala, Sweden , Uppsala (Sweden)
  • 7 INSERM U1046, CNRS UMR 9214, University of Montpellier, Montpellier, France , Montpellier (France)
  • 8 Medical University Vienna, Vienna, Austria , Vienna (Austria)
  • 9 Sheffield Teaching Hospitals, Sheffield and University of Sheffield, Sheffield, UK , Sheffield (United Kingdom)
  • 10 Massachusetts General Hospital, Boston, USA , Boston (United States)
  • 11 Queen Mary University of London, London, UK , London (United Kingdom)
  • 12 University Hospital Bonn, Bonn, Germany , Bonn (Germany)
  • 13 University of Insubria, Varese, Italy , Varese (Italy)
  • 14 Bergmannstrost Hospital, Halle, Germany , Halle (Germany)
  • 15 Policlinico San Martino Hospital – IRCCS for Oncology and Neurosciences, Genoa, Italy , Genoa (Italy)
  • 16 University of Genoa Italy, Genoa, Italy , Genoa (Italy)
  • 17 Technische Universität Dresden, Dresden, Germany , Dresden (Germany)
  • 18 Mahidol University, Bangkok, Thailand , Bangkok (Thailand)
  • 19 University of Oxford, Oxford, UK , Oxford (United Kingdom)
Type
Published Article
Journal
BMC Anesthesiology
Publisher
Springer (Biomed Central Ltd.)
Publication Date
Mar 19, 2021
Volume
21
Issue
1
Identifiers
DOI: 10.1186/s12871-021-01268-y
Source
Springer Nature
Keywords
License
Green

Abstract

BackgroundIt is uncertain whether the association of the intraoperative driving pressure (ΔP) with postoperative pulmonary complications (PPCs) depends on the surgical approach during abdominal surgery. Our primary objective was to determine and compare the association of time–weighted average ΔP (ΔPTW) with PPCs. We also tested the association of ΔPTW with intraoperative adverse events.MethodsPosthoc retrospective propensity score–weighted cohort analysis of patients undergoing open or closed abdominal surgery in the ‘Local ASsessment of Ventilatory management during General Anaesthesia for Surgery’ (LAS VEGAS) study, that included patients in 146 hospitals across 29 countries. The primary endpoint was a composite of PPCs. The secondary endpoint was a composite of intraoperative adverse events.ResultsThe analysis included 1128 and 906 patients undergoing open or closed abdominal surgery, respectively. The PPC rate was 5%. ΔP was lower in open abdominal surgery patients, but ΔPTW was not different between groups. The association of ΔPTW with PPCs was significant in both groups and had a higher risk ratio in closed compared to open abdominal surgery patients (1.11 [95%CI 1.10 to 1.20], P < 0.001 versus 1.05 [95%CI 1.05 to 1.05], P < 0.001; risk difference 0.05 [95%CI 0.04 to 0.06], P < 0.001). The association of ΔPTW with intraoperative adverse events was also significant in both groups but had higher odds ratio in closed compared to open abdominal surgery patients (1.13 [95%CI 1.12– to 1.14], P < 0.001 versus 1.07 [95%CI 1.05 to 1.10], P < 0.001; risk difference 0.05 [95%CI 0.030.07], P < 0.001).ConclusionsΔP is associated with PPC and intraoperative adverse events in abdominal surgery, both in open and closed abdominal surgery.Trial registrationLAS VEGAS was registered at clinicaltrials.gov (trial identifier NCT01601223).

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