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

the LAS VEGAS study–investigators; the PROtective VEntilation NETwork; the Clinical Trial Network of the European Society of Anaesthesiology

doi:10.1186/s12871-021-01268-y

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

the LAS VEGAS study–investigators, the PROtective VEntilation NETwork, the Clinical Trial Network of the European Society of Anaesthesiology

Research output: Contribution to journal › Article › peer-review

11 Citations (Scopus)

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 (ΔP_TW) with PPCs. We also tested the association of ΔP_TW 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 ΔP_TW was not different between groups. The association of ΔP_TW 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 ΔP_TW 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).

Original language	English
Article number	84
Number of pages	15
Journal	BMC Anesthesiology
Volume	21
DOIs	https://doi.org/10.1186/s12871-021-01268-y
Publication status	Published - 19 Mar 2021

Keywords

Driving pressure
Laparoscopic surgery
Laparoscopy
PEEP
Perioperative ventilation
Pneumoperitoneum
Protective ventilation
Respiratory mechanics

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the LAS VEGAS study–investigators, the PROtective VEntilation NETwork, & the Clinical Trial Network of the European Society of Anaesthesiology (2021). 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. BMC Anesthesiology, 21, [84]. https://doi.org/10.1186/s12871-021-01268-y

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. / the LAS VEGAS study–investigators; the PROtective VEntilation NETwork; the Clinical Trial Network of the European Society of Anaesthesiology.

In: BMC Anesthesiology, Vol. 21, 84, 19.03.2021.

Research output: Contribution to journal › Article › peer-review

the LAS VEGAS study–investigators, the PROtective VEntilation NETwork & the Clinical Trial Network of the European Society of Anaesthesiology 2021, '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', BMC Anesthesiology, vol. 21, 84. https://doi.org/10.1186/s12871-021-01268-y

the LAS VEGAS study–investigators, the PROtective VEntilation NETwork, the Clinical Trial Network of the European Society of Anaesthesiology. 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. BMC Anesthesiology. 2021 Mar 19;21:84. doi: 10.1186/s12871-021-01268-y

the LAS VEGAS study–investigators ; the PROtective VEntilation NETwork ; the Clinical Trial Network of the European Society of Anaesthesiology. / 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. In: BMC Anesthesiology. 2021 ; Vol. 21.

@article{87db20a340684db69218eca1ad1da291,

title = "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 {\textquoteleft}Local ASsessment of Ventilatory management during General Anaesthesia for Surgery{\textquoteright} (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).",

keywords = "Driving pressure, Laparoscopic surgery, Laparoscopy, PEEP, Perioperative ventilation, Pneumoperitoneum, Protective ventilation, Respiratory mechanics",

author = "Guido Mazzinari and {Serpa Neto}, Ary and Hemmes, {Sabrine N.T.} and Goran Hedenstierna and Samir Jaber and Michael Hiesmayr and Hollmann, {Markus W.} and Mills, {Gary H.} and {Vidal Melo}, {Marcos F.} and Pearse, {Rupert M.} and Christian Putensen and Werner Schmid and Paolo Severgnini and Hermann Wrigge and Cambronero, {Oscar Diaz} and Lorenzo Ball and {de Abreu}, {Marcelo Gama} and Paolo Pelosi and Schultz, {Marcus J.} and Wolfgang Kroell and Helfried Metzler and Gerd Struber and Thomas Wegscheider and Hans Gombotz and Bernhard Urbanek and David Kahn and Mona Momeni and Audrey Pospiech and Fernande Lois and Patrice Forget and Irina Grosu and Jan Poelaert and {van Mossevelde}, Veerle and {van Malderen}, {Marie Claire} and Dimitri Dylst and {van Melkebeek}, Jeroen and Maud Beran and {de Hert}, Stefan and {De Baerdemaeker}, Luc and Bjorn Heyse and {Van Limmen}, Jurgen and Piet Wyffels and Tom Jacobs and Nathalie Roels and {De Bruyne}, Ann and {van de Velde}, Stijn and Brigitte Leva and John Williams and Clare Jackson and Thomas Smith and {the LAS VEGAS study–investigators} and {the PROtective VEntilation NETwork} and {the Clinical Trial Network of the European Society of Anaesthesiology}",

note = "Funding Information: G. Mazzinari: No interest declared; A. Serpa Neto: No interest declared; S.N.T. Hemmes: No interest declared; G. Hedenstierna: No interest declared; S. Jaber: No interest declared; M. Hiesmayr: No interest declared; M.W. Hollmann: Executive Section Editor Pharmacology with Anesthesia & Analgesia, Section Editor Anesthesiology with Journal of Clinical Medicine, and CSL Behring, no conflict of interest with the current work; G.H. Mills: No interest declared; M.F. Vidal Melo: is funded by NIH/NHLBI grant UH3-HL140177; R.M. Pearse: No interest declared; C. Putensen: No interest declared; W. Schmid: No interest declared; P. Severgnini: No interest declared; H.Wrigge: No interest declared; O. Diaz–Cambronero: had received a Merck Sharp & Dohme investigator–initiated grant (protocol code #53607). Sponsors and funders have no roles in study design, analysis of data or reporting. Also received speakers fees for lecture and medical advice from Merck Sharp & Dohme, no conflict of interest with the current work; L.Ball: No interest declared; M. Gama de Abreu: Ambu, GE Healthcare, ZOLL consulting fees, no conflict of interest with the current work; P.Pelosi: No interest declared; M.J.Schultz: No interest declared. Funding Information: The ethical committee of the Academic Medical Center, Amsterdam, the Netherlands, approved the LAS VEGAS study protocol (W12_190#12.17.0227). Each participating centre obtained approval from their institutional review board if needed, and patients were included after obtaining written informed consent when dictated by national or regional legislation. The LAS VEGAS study was partially funded and endorsed by the European Society of Anaesthesiology and registered at clinicaltrials.gov (study identifier NCT01601223, first posted date: 17/05/2012). ",

year = "2021",

month = mar,

day = "19",

doi = "10.1186/s12871-021-01268-y",

language = "English",

volume = "21",

journal = "BMC Anesthesiology",

issn = "1471-2253",

publisher = "BioMed Central",

}

TY - JOUR

T1 - The Association of Intraoperative driving pressure with postoperative pulmonary complications in open versus closed abdominal surgery patients

T2 - a posthoc propensity score–weighted cohort analysis of the LAS VEGAS study

AU - Mazzinari, Guido

AU - Serpa Neto, Ary

AU - Hemmes, Sabrine N.T.

AU - Hedenstierna, Goran

AU - Jaber, Samir

AU - Hiesmayr, Michael

AU - Hollmann, Markus W.

AU - Mills, Gary H.

AU - Vidal Melo, Marcos F.

AU - Pearse, Rupert M.

AU - Putensen, Christian

AU - Schmid, Werner

AU - Severgnini, Paolo

AU - Wrigge, Hermann

AU - Cambronero, Oscar Diaz

AU - Ball, Lorenzo

AU - de Abreu, Marcelo Gama

AU - Pelosi, Paolo

AU - Schultz, Marcus J.

AU - Kroell, Wolfgang

AU - Metzler, Helfried

AU - Struber, Gerd

AU - Wegscheider, Thomas

AU - Gombotz, Hans

AU - Urbanek, Bernhard

AU - Kahn, David

AU - Momeni, Mona

AU - Pospiech, Audrey

AU - Lois, Fernande

AU - Forget, Patrice

AU - Grosu, Irina

AU - Poelaert, Jan

AU - van Mossevelde, Veerle

AU - van Malderen, Marie Claire

AU - Dylst, Dimitri

AU - van Melkebeek, Jeroen

AU - Beran, Maud

AU - de Hert, Stefan

AU - De Baerdemaeker, Luc

AU - Heyse, Bjorn

AU - Van Limmen, Jurgen

AU - Wyffels, Piet

AU - Jacobs, Tom

AU - Roels, Nathalie

AU - De Bruyne, Ann

AU - van de Velde, Stijn

AU - Leva, Brigitte

AU - Williams, John

AU - Jackson, Clare

AU - Smith, Thomas

AU - the LAS VEGAS study–investigators

AU - the PROtective VEntilation NETwork

AU - the Clinical Trial Network of the European Society of Anaesthesiology

N1 - Funding Information: G. Mazzinari: No interest declared; A. Serpa Neto: No interest declared; S.N.T. Hemmes: No interest declared; G. Hedenstierna: No interest declared; S. Jaber: No interest declared; M. Hiesmayr: No interest declared; M.W. Hollmann: Executive Section Editor Pharmacology with Anesthesia & Analgesia, Section Editor Anesthesiology with Journal of Clinical Medicine, and CSL Behring, no conflict of interest with the current work; G.H. Mills: No interest declared; M.F. Vidal Melo: is funded by NIH/NHLBI grant UH3-HL140177; R.M. Pearse: No interest declared; C. Putensen: No interest declared; W. Schmid: No interest declared; P. Severgnini: No interest declared; H.Wrigge: No interest declared; O. Diaz–Cambronero: had received a Merck Sharp & Dohme investigator–initiated grant (protocol code #53607). Sponsors and funders have no roles in study design, analysis of data or reporting. Also received speakers fees for lecture and medical advice from Merck Sharp & Dohme, no conflict of interest with the current work; L.Ball: No interest declared; M. Gama de Abreu: Ambu, GE Healthcare, ZOLL consulting fees, no conflict of interest with the current work; P.Pelosi: No interest declared; M.J.Schultz: No interest declared. Funding Information: The ethical committee of the Academic Medical Center, Amsterdam, the Netherlands, approved the LAS VEGAS study protocol (W12_190#12.17.0227). Each participating centre obtained approval from their institutional review board if needed, and patients were included after obtaining written informed consent when dictated by national or regional legislation. The LAS VEGAS study was partially funded and endorsed by the European Society of Anaesthesiology and registered at clinicaltrials.gov (study identifier NCT01601223, first posted date: 17/05/2012).

PY - 2021/3/19

Y1 - 2021/3/19

N2 - 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).

AB - 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).

KW - Driving pressure

KW - Laparoscopic surgery

KW - Laparoscopy

KW - PEEP

KW - Perioperative ventilation

KW - Pneumoperitoneum

KW - Protective ventilation

KW - Respiratory mechanics

UR - http://www.scopus.com/inward/record.url?scp=85102932125&partnerID=8YFLogxK

U2 - 10.1186/s12871-021-01268-y

DO - 10.1186/s12871-021-01268-y

M3 - Article

C2 - 33740885

AN - SCOPUS:85102932125

VL - 21

JO - BMC Anesthesiology

JF - BMC Anesthesiology

SN - 1471-2253

M1 - 84

ER -

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

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