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Research Article
Guido Mazzinari
Hospital Universitario y Politècnic La Fe
Corresponding Author
License:
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Background: It is uncertain whether associations between driving pressure (ΔP) during and occurrence of pulmonary complications after abdominal surgery depend on the surgical approach. Our primary objective was to test the time–weighted average ΔP (ΔPTW) association with postoperative pulmonary complications and our secondary objective was to test the association between ΔPTW and intraoperative Adverse Events.
Methods: We realized a posthoc retrospective propensity score weighted cohort analysis of the ‘Local ASsessment of Ventilatory management during General Anesthesia for Surgery’ (LAS VEGAS) study including patients undergoing abdominal surgery from the study database including data from 146 hospitals across 29 countries. The primary endpoint was a composite of postoperative pulmonary complications. The secondary endpoint was the occurrence of intraoperative adverse events.
Results: The analysis included 1,128 and 906 patients undergoing open or closed abdominal surgery repsectively. Absolute postoperative pulmonary complications rate was 5%. While driving pressure was lower in open abdominal surgery patients, time-weighted driving pressure was not different between groups. The association of ΔPTW with occurrence of postoperative pulmonary complications was significant in both groups, with a higher risk ratio in closed than in open abdominal surgery patients (1.11 [95%CI 1.10 to 1.20], P<0.001 vs. 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). ΔPTW marginal effect estimation showed increased probability of pulmonary complication in both groups with a steeper increase in closed surgery patients at ΔPTW above 20 cmH2O∙hour-1. The association of ΔPTW with occurrence of intraoperative adverse events was also significant in both groups, with higher odds ratio in closed surgery (1.13 [95%CI 1.12 to 1.14]; P<0.001 vs. 1.07 [95%CI 1.05 to 1.10]; P<0.001; difference 0.05 [95%CI 0.03 to 0.07]; p<0.001).
Conclusions: Our results show how driving pressure represents a marker for pulmonary complications and adverse events in abdominal surgery regardless of surgical approach.
Trial registration: LAS VEGAS was registered at clinicaltrials.gov (trial identifier NCT01601223).
Keywords
Pneumoperitoneum, laparoscopy, laparoscopic surgery, perioperative ventilation, protective ventilation, PEEP, respiratory mechanics, driving pressure.
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CURRENT STATUS: Published
View the published article at BMC Anesthesiology.
Version 1
Posted 24 Nov, 2020
No community comments so far
Editorial decision: Major revision
On 10 Dec, 2020
Reviews received
Received 27 Nov, 2020
Reviewers agreed
On 25 Nov, 2020
Reviewers agreed
On 20 Nov, 2020
Reviewers invited
Invitations sent on 18 Nov, 2020
Editor assigned
On 18 Nov, 2020
Editor invited
On 18 Nov, 2020
Submission checks complete
On 18 Nov, 2020
First submitted
On 12 Nov, 2020
Metrics
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Subject Areas
Anesthesiology & Pain Medicine
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A new preprint design is coming!
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See the published version of this preprint at BMC Anesthesiology.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
Guido Mazzinari
Hospital Universitario y Politècnic La Fe
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Anesthesiology.
Version 1
Posted 24 Nov, 2020
No community comments so far
Editorial decision: Major revision
On 10 Dec, 2020
Reviews received
Received 27 Nov, 2020
Reviewers agreed
On 25 Nov, 2020
Reviewers agreed
On 20 Nov, 2020
Reviewers invited
Invitations sent on 18 Nov, 2020
Editor assigned
On 18 Nov, 2020
Editor invited
On 18 Nov, 2020
Submission checks complete
On 18 Nov, 2020
First submitted
On 12 Nov, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Anesthesiology & Pain Medicine
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Anesthesiology.
Background: It is uncertain whether associations between driving pressure (ΔP) during and occurrence of pulmonary complications after abdominal surgery depend on the surgical approach. Our primary objective was to test the time–weighted average ΔP (ΔPTW) association with postoperative pulmonary complications and our secondary objective was to test the association between ΔPTW and intraoperative Adverse Events.
Methods: We realized a posthoc retrospective propensity score weighted cohort analysis of the ‘Local ASsessment of Ventilatory management during General Anesthesia for Surgery’ (LAS VEGAS) study including patients undergoing abdominal surgery from the study database including data from 146 hospitals across 29 countries. The primary endpoint was a composite of postoperative pulmonary complications. The secondary endpoint was the occurrence of intraoperative adverse events.
Results: The analysis included 1,128 and 906 patients undergoing open or closed abdominal surgery repsectively. Absolute postoperative pulmonary complications rate was 5%. While driving pressure was lower in open abdominal surgery patients, time-weighted driving pressure was not different between groups. The association of ΔPTW with occurrence of postoperative pulmonary complications was significant in both groups, with a higher risk ratio in closed than in open abdominal surgery patients (1.11 [95%CI 1.10 to 1.20], P<0.001 vs. 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). ΔPTW marginal effect estimation showed increased probability of pulmonary complication in both groups with a steeper increase in closed surgery patients at ΔPTW above 20 cmH2O∙hour-1. The association of ΔPTW with occurrence of intraoperative adverse events was also significant in both groups, with higher odds ratio in closed surgery (1.13 [95%CI 1.12 to 1.14]; P<0.001 vs. 1.07 [95%CI 1.05 to 1.10]; P<0.001; difference 0.05 [95%CI 0.03 to 0.07]; p<0.001).
Conclusions: Our results show how driving pressure represents a marker for pulmonary complications and adverse events in abdominal surgery regardless of surgical approach.
Trial registration: LAS VEGAS was registered at clinicaltrials.gov (trial identifier NCT01601223).
Figure 1
Figure 1
Figure 2
Figure 2
Figure 3
Figure 3
This is a list of supplementary files associated with this preprint. Click to download.
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