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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Date
2021-03-19ICR Author
Author
Mazzinari, G
Serpa Neto, A
Hemmes, SNT
Hedenstierna, G
Jaber, S
Hiesmayr, M
Hollmann, MW
Mills, GH
Vidal Melo, MF
Pearse, RM
Putensen, C
Schmid, W
Severgnini, P
Wrigge, H
Cambronero, OD
Ball, L
de Abreu, MG
Pelosi, P
Schultz, MJ
LAS VEGAS study–investigators,
PROtective VEntilation NETwork,
Clinical Trial Network of the European Society of Anaesthesiology,
Type
Journal Article
Metadata
Show full item recordAbstract
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 ).
Collections
Subject
LAS VEGAS study–investigators
PROtective VEntilation NETwork
Clinical Trial Network of the European Society of Anaesthesiology
Abdomen
Humans
Lung Diseases
Postoperative Complications
Laparoscopy
Respiration, Artificial
Positive-Pressure Respiration
Anesthesia, General
Retrospective Studies
Cohort Studies
Adult
Aged
Middle Aged
Female
Male
Propensity Score
Language
eng
Date accepted
2021-01-25
License start date
2021-03-19
Citation
BMC anesthesiology, 2021, 21 (1), pp. 84 - ?
Publisher
BMC
Except where otherwise noted, this item's license is described
as
http://creativecommons.org/licenses/by/4.0/
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