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

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Hospital Universitario La Fe
  • Hospital Israelita Albert Einstein
  • Universidade de São Paulo
  • University of Amsterdam
  • Uppsala University
  • University of Montpellier
  • Medical University of Vienna
  • University of Sheffield
  • Harvard University
  • Queen Mary University of London
  • University of Bonn
  • University of Insubria
  • Hospital Bergmannstrost
  • University of Genoa
  • Mahidol University
  • University of Oxford

Abstract

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).

Details

Original languageEnglish
Article number84
Pages (from-to)1-15
Number of pages15
JournalBMC anesthesiology
Volume21
Issue number1
Publication statusPublished - 1 Dec 2021
Peer-reviewedYes

External IDs

PubMed 33740885
ORCID /0000-0002-5385-9607/work/151433483
ORCID /0000-0003-3953-3253/work/151438216

Keywords

ASJC Scopus subject areas

Keywords

  • Driving pressure, Laparoscopic surgery, Laparoscopy, PEEP, Perioperative ventilation, Pneumoperitoneum, Protective ventilation, Respiratory mechanics

Library keywords