Effects of Intra-operative Cardiopulmonary Variability On Post-operative Pulmonary Complications in Major Non-cardiac Surgery: A Retrospective Cohort Study

被引:0
|
作者
Ranjeva, Sylvia [1 ]
Nagebretsky, Alexander [1 ]
Odozynski, Gabriel [2 ]
Fernandez-Bustamante, Ana [3 ]
Frendl, Gyorgy [4 ]
Gupta, R. Alok [5 ]
Sprung, Juraj [6 ]
Subramaniam, Bala [7 ]
Ruiz, Ricardo Martinez [8 ]
Bartels, Karsten [9 ]
Giquel, Jadelis [10 ]
Lee, Jae-Woo [11 ]
Houle, Timothy [12 ]
Melo, Marcos Francisco Vidal [13 ]
机构
[1] Massachusetts Gen Hosp, Dept Anesthesia Crit Care & Pain Med, Boston, MA 02114 USA
[2] Univ Fed Santa Catarina, Florianopolis, SC, Brazil
[3] Univ Colorado, Sch Med, Dept Anesthesiol, Aurora, CO USA
[4] Harvard Med Sch, Brigham & Womens Hosp, Dept Anesthesiol Perioperat & Pain Med, Boston, MA USA
[5] Northwestern Univ, Dept Anesthesiol, Chicago, IL USA
[6] Mayo Clin, Dept Anesthesiol, Rochester, MI USA
[7] Beth Israel Deaconess Med Ctr, Dept Anesthesiol, Boston, MA 02215 USA
[8] NCH Healthcare Syst, Dept Anesthesiol, Miami, FL USA
[9] Univ Nebraska, Dept Anesthesiol, Med Ctr, Omaha, NE USA
[10] Univ Miami, Dept Anesthesiol, Hosp & Clin, Miami, FL 33136 USA
[11] Univ Calif San Francisco, Dept Neurol, San Francisco, CA USA
[12] Massachusetts Gen Hosp, Anesthesia Res Ctr, Dept Anesthesiol, Boston, MA USA
[13] Columbia Univ, Irving Med Ctr, Dept Anesthesiol, New York, NY 10032 USA
基金
美国国家卫生研究院;
关键词
Postoperative pulmonary complications; Intraoperative respiratory variability; Intraoperative hemodynamic variability; Lung protective ventilation; MECHANICAL VENTILATION; METAANALYSIS; ASSOCIATION;
D O I
10.1007/s10916-024-02050-6
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Intraoperative cardiopulmonary variables are well-known predictors of postoperative pulmonary complications (PPC), traditionally quantified by median values over the duration of surgery. However, it is unknown whether cardiopulmonary instability, or wider intra-operative variability of the same metrics, is distinctly associated with PPC risk and severity. We leveraged a retrospective cohort of adults (n = 1202) undergoing major non-cardiothoracic surgery. We used multivariable logistic regression to evaluate the association of two outcomes (1)moderate-or-severe PPC and (2)any PPC with two sets of exposure variables- (a)variability of cardiopulmonary metrics (inter-quartile range, IQR) and (b)median intraoperative cardiopulmonary metrics. We compared predictive ability (receiver operating curve analysis, ROC) and parsimony (information criteria) of three models evaluating different aspects of the intra-operative cardiopulmonary metrics: Median-based: Median cardiopulmonary metrics alone, Variability-based: IQR of cardiopulmonary metrics alone, and Combined: Medians and IQR. Models controlled for peri-operative/surgical factors, demographics, and comorbidities. PPC occurred in 400(33%) of patients, and 91(8%) experienced moderate-or-severe PPC. Variability in multiple intra-operative cardiopulmonary metrics was independently associated with risk of moderate-or-severe, but not any, PPC. For moderate-or-severe PPC, the best-fit predictive model was the Variability-based model by both information criteria and ROC analysis (area under the curve, AUCVariability-based = 0.74 vs AUCMedian-based = 0.65, p = 0.0015; AUCVariability-based = 0.74 vs AUCCombined = 0.68, p = 0.012). For any PPC, the Median-based model yielded the best fit by information criteria. Predictive accuracy was marginally but not significantly higher for the Combined model (AUCCombined = 0.661) than for the Median-based (AUCMedian-based = 0.657, p = 0.60) or Variability-based (AUCVariability-based = 0.649, p = 0.29) models. Variability of cardiopulmonary metrics, distinct from median intra-operative values, is an important predictor of moderate-or-severe PPC.
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页数:11
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