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Epidemiology, practice of ventilation and outcome for patients at increased risk of postoperative pulmonary complications: LAS VEGAS - An observational study in 29 countries
Scopus
Open Access Toplam 270 atıf DOI
Background: Limited information exists about the epidemiology and outcome of surgical patients at increased risk of postoperative pulmonary complications (PPCs), and how intraoperative ventilation was managed in these patients. Objectives: To determine the incidence of surgical patients at increased risk of PPCs, and to compare the intraoperative ventilation management and postoperative outcomes with patients at low risk of PPCs. Design: This was a prospective international 1-week observational study using the 'Assess Respiratory Risk in Surgical Patients in Catalonia risk score' (ARISCAT score) for PPC for risk stratification. Patients and Setting: Adult patients requiring intraoperative ventilation during general anaesthesia for surgery in 146 hospitals across 29 countries. Main Outcome Measures: The primary outcome was the incidence of patients at increased risk of PPCs based on the ARISCAT score. Secondary outcomes included intraoperative ventilatory management and clinical outcomes. Results: A total of 9864 patients fulfilled the inclusion criteria. The incidence of patients at increased risk was 28.4%. The most frequently chosen tidal volume (VT) size was 500 ml, or 7 to 9 ml kg-1 predicted body weight, slightly lower in patients at increased risk of PPCs. Levels of positive end-expiratory pressure (PEEP) were slightly higher in patients at increased risk of PPCs, with 14.3% receiving more than 5 cmH 2 O PEEP compared with 7.6% in patients at low risk of PPCs (P < 0.001). Patients with a predicted preoperative increased risk of PPCs developed PPCs more frequently: 19 versus 7%, relative risk (RR) 3.16 (95% confidence interval 2.76 to 3.61), P < 0.001) and had longer hospital stays. The only ventilatory factor associated with the occurrence of PPCs was the peak pressure. Conclusion: The incidence of patients with a predicted increased risk of PPCs is high. A large proportion of patients receive high VT and low PEEP levels. PPCs occur frequently in patients at increased risk, with worse clinical outcome.
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Pulmonary complications following urological, gastrointestinal and gynaecological abdominal Surgery––A post-hoc analysis of an observational study in 29 countries
Scopus
Havuzumuzda Open Access 3 atıf almış
Background: The incidence of postoperative pulmonary complications (PPCs33Postoperative Pulmonary Complications.) following abdominal surgery varies across surgical specialties. It remains unclear to what extent the incidence of PPCs is attributable to known patient–related factors and anaesthesia duration, rather than to differences inherent to the surgical specialty itself. Methods: Post-hoc analysis of an observational study describing postoperative outcomes in patients undergoing urological, gastrointestinal, and gynaecological abdominal surgery. The primary endpoint was a composite measure of PPCs. Secondary endpoints included the individual incidence of each PPC. Propensity score weighting was used to create a cohort with similar patient characteristics and anaesthesia duration. Results: The cohort consisted of 3306 patients across 146 centres in 29 countries–367 underwent urological surgery, 2100 underwent gastrointestinal surgery, and 839 underwent gynaecological surgery. Risk scores for PPCs were highest in urological surgical patients, followed by gastrointestinal and gynaecological surgical patients. PPCs also occurred most often after urological surgery (17.7%), followed by gastrointestinal (14.9%) and gynaecological surgery (9.8%) (p < 0.001). After weighting, these differences in incidence disappeared, with comparable rates across the three groups (urological surgery 15.7%, gastrointestinal 14.5%, gynaecological 12.2%; p = 0.340). Apart from unplanned supplementary oxygen, all PPCs were most frequent after gastrointestinal surgery and least common following gynaecological surgery. Conclusions: In this worldwide cohort of patients undergoing abdominal surgery, the incidence of PPCs varied across urological, gastrointestinal, and gynaecological surgery; the differences in incidence may be more strongly influenced by patient–related factors and anaesthesia duration than by the characteristics of the surgical specialty itself. Gastrointestinal surgeries showed the highest rates of severe PPCs.
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Kurumlar (17)
Amsterdam UMC - University of Amsterdam
Amsterdam, Netherlands
Antoni van Leeuwenhoek Ziekenhuis
Amsterdam, Netherlands
Austin Hospital
Melbourne, Australia
BG-Kliniken Bergmannstrost Halle
Halle, Germany
Cleveland Clinic Foundation
Cleveland, United States
Columbia University
New York, United States
Hospital Israelita Albert Einstein
Sao Paulo, Brazil
Mahidol Oxford Tropical Medicine Research Unit
Bangkok, Thailand
Massachusetts General Hospital
Boston, United States
Medizinische Universität Wien
Vienna, Austria