TY - JOUR
T1 - 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
AU - the LAS VEGAS study–investigators
AU - the PROtective VEntilation NETwork
AU - the Clinical Trial Network of the European Society of Anaesthesiology
AU - Mazzinari, Guido
AU - Serpa Neto, Ary
AU - Hemmes, Sabrine N.T.
AU - Hedenstierna, Goran
AU - Jaber, Samir
AU - Hiesmayr, Michael
AU - Hollmann, Markus W.
AU - Mills, Gary H.
AU - Vidal Melo, Marcos F.
AU - Pearse, Rupert M.
AU - Putensen, Christian
AU - Schmid, Werner
AU - Severgnini, Paolo
AU - Wrigge, Hermann
AU - Cambronero, Oscar Diaz
AU - Ball, Lorenzo
AU - de Abreu, Marcelo Gama
AU - Pelosi, Paolo
AU - Schultz, Marcus J.
AU - Kroell, Wolfgang
AU - Metzler, Helfried
AU - Struber, Gerd
AU - Wegscheider, Thomas
AU - Gombotz, Hans
AU - Urbanek, Bernhard
AU - Kahn, David
AU - Momeni, Mona
AU - Pospiech, Audrey
AU - Lois, Fernande
AU - Forget, Patrice
AU - Grosu, Irina
AU - Poelaert, Jan
AU - van Mossevelde, Veerle
AU - van Malderen, Marie Claire
AU - Dylst, Dimitri
AU - van Melkebeek, Jeroen
AU - Beran, Maud
AU - de Hert, Stefan
AU - De Baerdemaeker, Luc
AU - Heyse, Bjorn
AU - Van Limmen, Jurgen
AU - Wyffels, Piet
AU - Jacobs, Tom
AU - Roels, Nathalie
AU - De Bruyne, Ann
AU - van de Velde, Stijn
AU - Leva, Brigitte
AU - Damster, Sandrine
AU - Plichon, Benoit
AU - Kor, Daryl
N1 - Publisher Copyright:
© 2021, The Author(s).
PY - 2021/12/1
Y1 - 2021/12/1
N2 - Background: It 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. Methods: Posthoc 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. Results: The 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). Conclusions: ΔP is associated with PPC and intraoperative adverse events in abdominal surgery, both in open and closed abdominal surgery. Trial registration: LAS VEGAS was registered at clinicaltrials.gov (trial identifier NCT01601223).
AB - Background: It 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. Methods: Posthoc 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. Results: The 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). Conclusions: ΔP is associated with PPC and intraoperative adverse events in abdominal surgery, both in open and closed abdominal surgery. Trial registration: LAS VEGAS was registered at clinicaltrials.gov (trial identifier NCT01601223).
KW - Driving pressure
KW - Laparoscopic surgery
KW - Laparoscopy
KW - PEEP
KW - Perioperative ventilation
KW - Pneumoperitoneum
KW - Protective ventilation
KW - Respiratory mechanics
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U2 - 10.1186/s12871-021-01268-y
DO - 10.1186/s12871-021-01268-y
M3 - Article
C2 - 33740885
AN - SCOPUS:85102932125
SN - 1471-2253
VL - 21
JO - BMC Anesthesiology
JF - BMC Anesthesiology
IS - 1
M1 - 84
ER -