Journal Article

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

Hollmann, Markus W., Serpa Neto, Ary, Pearse, Rupert M., Schultz, Marcus J., Pelosi, Paolo, Ball, Lorenzo, Hemmes, Sabrine N. T., Jaber, Samir, de Abreu, Marcelo Gama, Mazzinari, Guido, Cambronero, Oscar Diaz, Hedenstierna, Goran, Schmid, Werner, Vidal Melo, Marcos F., Hiesmayr, Michael, Wrigge, Hermann, Severgnini, Paolo, Mills, Gary H., Putensen, Christian

2021

Overview

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 (ΔP TW ) with PPCs. We also tested the association of ΔP 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%. ΔP was lower in open abdominal surgery patients, but ΔP TW was not different between groups. The association of ΔP 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 ΔP 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 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 ).

• Publisher: BioMed Central,Springer Nature B.V,BMC
• Subject: Abdomen / Abdomen - surgery / Abdominal surgery / Adult / Adverse events / Aged / Anesthesia / Anesthesia, General / Anesthesiology / Cohort analysis / Cohort Studies / Critical Care Medicine / Diaphragm (Anatomy) / Driving pressure / Emergency Medicine / Female / General anesthesia / Humans / Hypotheses / Intensive / Internal Medicine / Laparoscopic surgery / Laparoscopy / Life Sciences / Lung Diseases - epidemiology / Male / Medicine / Medicine & Public Health / Middle Aged / Mortality / Patients / PEEP / Perioperative ventilation / Pneumoperitoneum / Positive-Pressure Respiration / Postoperative Complications - epidemiology / Propensity Score / Protective ventilation / Research Article / Respiration, Artificial - statistics & numerical data / Respiratory mechanics / Retrospective Studies / Surgery / Variables