Association between averaged intraoperative nociceptive response index and postoperative complications after lung resection surgery

Abstract

OBJECTIVES Since postoperative complications, defined as Clavien-Dindo grade ≥ II, correlate with long-term survival after lung resection surgery in patients with primary lung cancer, identification of intraoperative risk factors for postoperative complications is crucial for better perioperative management. In the present study, we investigated possible association between intraoperative variables for use in anaesthetic management and Clavien-Dindo grade ≥ II. METHODS In this multi-institutional observational study, consecutive adult patients undergoing video-assisted thoracic surgery for primary lung cancer under general anaesthesia from March 2019 to April 2021 were enrolled. All patients were divided into two groups with Clavien-Dindo grade < II and ≥ II. Uni- and multivariable analyses were performed to identify intraoperative risk factors. RESULTS After univariable analysis between patients with Clavien-Dindo grade < II (n = 415) and ≥ II (n = 121), multivariable analysis revealed higher averaged nociceptive response (NR) index during surgery (mean NR), male sex, lower body mass index, longer duration of surgery, higher blood loss, and lower urine volume, as independent risk factors for postoperative complications. In sensitivity analysis, based on the cut-off value of mean NR for postoperative complications, all patients were divided into high and low mean NR groups. The incidence of postoperative complications was significantly higher in patients with high mean NR (n = 332) than in patients with low mean NR (n = 204; P < 0.001). CONCLUSIONS Higher mean NR, as intraoperative variables for use in anaesthetic management, is associated with higher incidence of postoperative complications after primary lung cancer surgery.

Intraoperative Assessment of Surgical Stress Response Using Nociception Monitor under General Anesthesia and Postoperative Complications: A Narrative Review

“…The neuroendocrine-metabolic response involves the sympathetic nervous system, endocrine system, and metabolic responses [ 3 , 46 ]. Sympathetic nervous system activation induces hemodynamic changes caused by increases in systemic vascular resistance, arterial blood pressure, and heart rate, and also induces hyperglycemia.…”

“…Higher values of NR averaged from the start to the end of surgery (mean NR), which are calculated using heart rate, systolic blood pressure, and peripheral perfusion index, were reportedly associated with a higher incidence of major postoperative complications, defined as a Clavien–Dindo Class ≥ IIIa, after gastrointestinal surgery ( Table 1 ) [ 44 ]. Mean NR values also increased in the order of severity of postoperative complications in patients undergoing total shoulder arthroplasty, gastrointestinal surgery, and thoracic surgery ( Figure 2 ) [ 44 , 45 , 46 , 84 , 85 ].…”

“…Gray circles show individual data points. Data in this graph were obtained from [ 44 , 45 , 46 , 84 , 85 ]. Significant differences are defined at * p < 0.001 vs. no complications, and # p < 0.001 vs. minor complications.…”

When nociception monitoring becomes predictive of surgical outcomes : has the future already become real ?

“…The reasoning goes as follow: surgical stress, mainly nociception, induces sympathetic activation and a chemical cascade of inflammatory mediators whose influence could be detected in order to anticipate negative outcomes, e.g. after lung resection [ 7 ], or gastrointestinal surgery [ 8 ], all documented on retrospective massive datasets and with averaging of the NR index over the whole duration of surgery. It is to note that despite its name (“Nociception Response index”), there has been no effort to measure the association between NR Index and any kind of standardized nociception or known endocrine response to nociception.…”