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

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).

Associations of dynamic driving pressure and mechanical power with postoperative pulmonary complications–posthoc analysis of two randomised clinical trials in open abdominal surgery

“…Compared to other cohorts of abdominal surgery patients, our patient cohort had similar baseline characteristics. 4 , 7 The incidence of postoperative pulmonary complications was 35·9%, which was high compared to other cohorts of patients undergoing abdominal surgery, 2 , 7 but was similar to studies in patients with intermediate–high risk for postoperative pulmonary complications following the ARISCAT classification. 19 , 20 Multiple studies on intraoperative driving pressure have reported similar driving pressure values, 5 , 8 , 24 even in open abdominal surgery.…”

“… 19 , 20 Multiple studies on intraoperative driving pressure have reported similar driving pressure values, 5 , 8 , 24 even in open abdominal surgery. 7 Thus far, the intraoperative mechanical power has been reported in cardiothoracic, thoracic, and non–thoracic surgery patients and was slightly higher to that in our patient cohort, with median mechanical power of approximately 8–9 J/min. 24 , 25 , 26 Comparing the two original studies, dynamic mechanical power in the PROBESE study was higher compared to the PROVHILO study, which could be attributed to a higher body mass index in these patients leading to lower chest wall compliance.…”

“…Postoperative pulmonary complications often occur in patients after major surgery and result in attributable morbidity and mortality. 1 , 2 , 3 Previous work suggests that a high tidal volume, 4 a high driving pressure, 5 , 6 , 7 , 8 and also a high flow and a high respiratory rate 4 can induce lung injury. Changing one of these variables could inadvertently affect the other three variables.…”

Effects of dynamic individualized PEEP guided by driving pressure in laparoscopic surgery on postoperative atelectasis in elderly patients: a prospective randomized controlled trial

“…A higher ΔP during abdominal closure surgery is usually considered innocent. However, recent research negates this hypothesis [ 20 ]. This study point to a stronger correlation between ΔP in laparoscopic surgery than in abdominal surgery in the analysis of ΔP and postoperative pulmonary complications.…”

Evaluation of Lung Aeration and Respiratory System Mechanics in Obese Dogs Ventilated With Tidal Volumes Based on Ideal vs. Current Body Weight

“…Aggressive mechanical ventilation leading to excessive parenchymal deformation in people has been associated with a high incidence of postoperative pulmonary complications (29,30). Therefore, the appropriate setting of intraoperative ventilatory variables seems to play an important role in protecting the lungs from ventilator-induced lung injury.…”