Intraoperative Driving Pressure and Postoperative Pulmonary Complications After Abdominal Surgery – A Posthoc Propensity Score–Weighted Cohort Analysis of the LAS VEGAS Study Comparing Open to Closed Surgery

Guido Mazzinari (1) , Ary Serpa Neto (2, 3, 4) , Sabrine N. T. Hemmes (4) , Göran Hedenstierna (5) , Samir Jaber (6) , Michael Hiesmayr (7) , Markus W. Hollmann (4) , Gary Mills (8) , Marcos Francisco Vidal Melo (9) , Rupert M. Pearse (10) , Christian Putensen (11) , Werner Schmid (7) , Paolo Severgnini (12) , Oscar Diaz-Cambronero (1) , Hermann Wrigge (13) , Lorenzo Ball (14) , Marcelo Gama De Abreu (15) , Paolo Pelosi (14) , Marcus J. Schultz (4, 16, 17)

1 Hospital Universitari i Politècnic La Fe = University and Polytechnic Hospital La Fe
2 Hospital Israelita Albert Einstein [São Paulo, Brazil]
3 USP - Universidade de São Paulo = University of São Paulo
4 AMC - Academic Medical Center - Academisch Medisch Centrum [Amsterdam]
5 Uppsala University
6 PhyMedExp - Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046]
7 Medizinische Universität Wien = Medical University of Vienna
8 University of Sheffield [Sheffield]
9 Massachusetts General Hospital [Boston, MA, USA]
10 QMUL - Queen Mary University of London
11 University Hospital Bonn
12 Uninsubria - Universitá degli Studi dell’Insubria = University of Insubria [Varese]
13 Department of Anaesthesiology, Intensive Care and Emergency Medicine, Pain Therapy, Bergmannstrost Hospital Halle, 06112, Halle
14 UniGe - Università degli studi di Genova = University of Genoa
15 TU Dresden - Technische Universität Dresden = Dresden University of Technology
16 MORU - Mahidol Oxford Tropical Medicine Research Unit
17 Nuffield Department of Clinical Medicine [Oxford]

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 (ΔP TW ) association with postoperative pulmonary complications and our secondary objective was to test the association between ΔP TW 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 ΔP TW 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). ΔP TW marginal effect estimation showed increased probability of pulmonary complication in both groups with a steeper increase in closed surgery patients at ΔP TW above 20 cmH 2 O∙hour -1 . The association of ΔP TW 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).

Mots clés: Pneumoperitoneum; Laparoscopy; Laparoscopic surgery; Perioperative ventilation; Protective ventilation; PEEP; Respiratory mechanics; Driving pressure

Domaines: Sciences du Vivant [q-bio]

Guido Mazzinari, Ary Serpa Neto, Sabrine N. T. Hemmes, Göran Hedenstierna, Samir Jaber, et al.. Intraoperative Driving Pressure and Postoperative Pulmonary Complications After Abdominal Surgery – A Posthoc Propensity Score–Weighted Cohort Analysis of the LAS VEGAS Study Comparing Open to Closed Surgery. BMC Anesthesiology, 2021, 21, pp.84. ⟨10.1186/s12871-021-01268-y⟩. ⟨hal-03029293⟩