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.


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Mazzinari G., Serpa Neto A., Hemmes S. N. T. , Hedenstierna G., Jaber S., Hiesmayr M., ...More

BMC anesthesiology, vol.21, pp.84, 2021 (Journal Indexed in SCI) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 21
  • Publication Date: 2021
  • Doi Number: 10.1186/s12871-021-01268-y
  • Title of Journal : BMC anesthesiology
  • Page Numbers: pp.84
  • Keywords: Pneumoperitoneum, Laparoscopy, Laparoscopic surgery, Perioperative ventilation, Protective ventilation, PEEP, Respiratory mechanics, Driving pressure, CHEST-WALL MECHANICS, OPEN-LUNG APPROACH, LAPAROSCOPIC CHOLECYSTECTOMY, TRANSPULMONARY PRESSURE, RESPIRATORY MECHANICS, VENTILATION, PNEUMOPERITONEUM, DEFINITIONS, ANESTHESIA

Abstract

Background It is uncertain whether the association of the intraoperative driving pressure (Delta P) 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 Delta P (Delta P-TW) with PPCs. We also tested the association of Delta P-TW 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%. Delta P was lower in open abdominal surgery patients, but Delta P-TW was not different between groups. The association of Delta P-TW 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 Delta P-TW 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 Delta P 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).