Geo-economic variations in epidemiology, ventilation management and outcome of patients receiving intraoperative ventilation during general anesthesia- posthoc analysis of an observational study in 29 countries

Liselotte Hol; Sunny G L H Nijbroek; Ary Serpa Neto; Sabrine N T Hemmes; Goran Hedenstierna; Michael Hiesmayr; Markus W Hollmann; Gary H Mills; Marcos F Vidal Melo; Christian Putensen; Werner Schmid; Paolo Severgnini; Hermann Wrigge; Marcelo Gama de Abreu; Paolo Pelosi; Marcus J Schultz; LAS VEGAS study–investigators

doi:10.1186/s12871-021-01560-x

Geo-economic variations in epidemiology, ventilation management and outcome of patients receiving intraoperative ventilation during general anesthesia- posthoc analysis of an observational study in 29 countries

BMC Anesthesiol. 2022 Jan 7;22(1):15. doi: 10.1186/s12871-021-01560-x.

Authors

Liselotte Hol^{1

2}, Sunny G L H Nijbroek^{3

4}, Ary Serpa Neto^{4

5}, Sabrine N T Hemmes³, Goran Hedenstierna⁶, Michael Hiesmayr⁷, Markus W Hollmann³, Gary H Mills⁸, Marcos F Vidal Melo⁹, Christian Putensen¹⁰, Werner Schmid⁷, Paolo Severgnini¹¹, Hermann Wrigge¹², Marcelo Gama de Abreu^{13

14

15}, Paolo Pelosi^{16

17}, Marcus J Schultz^{4

18

19}; LAS VEGAS study–investigators

Affiliations

¹ Department of Anesthesiology, Amsterdam UMC, location AMC, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands. l.hol@amsterdamumc.nl.
² Department of Intensive Care, Amsterdam UMC, location AMC, Amsterdam, The Netherlands. l.hol@amsterdamumc.nl.
³ Department of Anesthesiology, Amsterdam UMC, location AMC, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.
⁴ Department of Intensive Care, Amsterdam UMC, location AMC, Amsterdam, The Netherlands.
⁵ Department of Critical Care Medicine, Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Monash University, Melbourne, Australia.
⁶ Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden.
⁷ Division Cardiac, Thoracic, Vascular Anesthesia and Intensive Care, Medical University Vienna, Vienna, Austria.
⁸ Operating Services, Critical Care and Anaesthesia, Sheffield Teaching Hospitals, Sheffield and University of Sheffield, Sheffield, UK.
⁹ Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA.
¹⁰ Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany.
¹¹ Department of Biotechnology and Life, ASST Sette Laghi Ospedale di Circolo e Fondazio Macchi, University of Insubria, Varese, Italy.
¹² Department of Anaesthesiology, Intensive Care Medicine and Emergency Medicine, Pain Therapy, Bermannstrost Hospital Halle, Halle, Germany.
¹³ Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany.
¹⁴ Department of Intensive Care and Resuscitation, Cleveland Clinic, Cleveland, OH, USA.
¹⁵ Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA.
¹⁶ Department of Surgical Sciences and Integrated Diagnostics, Università degli Studi di Genova, Genova, Italy.
¹⁷ Anesthesia and Critical Care, IRCCS for Oncology and Neurosciences, San Martino Policlinico Hospital, Genova, Italy.
¹⁸ Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand.
¹⁹ Nuffield Department of Medicine, University of Oxford, Oxford, UK.

Abstract

Background: The aim of this analysis is to determine geo-economic variations in epidemiology, ventilator settings and outcome in patients receiving general anesthesia for surgery.

Methods: Posthoc analysis of a worldwide study in 29 countries. Lower and upper middle-income countries (LMIC and UMIC), and high-income countries (HIC) were compared. The coprimary endpoint was the risk for and incidence of postoperative pulmonary complications (PPC); secondary endpoints were intraoperative ventilator settings, intraoperative complications, hospital stay and mortality.

Results: Of 9864 patients, 4% originated from LMIC, 11% from UMIC and 85% from HIC. The ARISCAT score was 17.5 [15.0-26.0] in LMIC, 16.0 [3.0-27.0] in UMIC and 15.0 [3.0-26.0] in HIC (P = .003). The incidence of PPC was 9.0% in LMIC, 3.2% in UMIC and 2.5% in HIC (P < .001). Median tidal volume in ml kg^{- 1} predicted bodyweight (PBW) was 8.6 [7.7-9.7] in LMIC, 8.4 [7.6-9.5] in UMIC and 8.1 [7.2-9.1] in HIC (P < .001). Median positive end-expiratory pressure in cmH₂O was 3.3 [2.0-5.0]) in LMIC, 4.0 [3.0-5.0] in UMIC and 5.0 [3.0-5.0] in HIC (P < .001). Median driving pressure in cmH₂O was 14.0 [11.5-18.0] in LMIC, 13.5 [11.0-16.0] in UMIC and 12.0 [10.0-15.0] in HIC (P < .001). Median fraction of inspired oxygen in % was 75 [50-80] in LMIC, 50 [50-63] in UMIC and 53 [45-70] in HIC (P < .001). Intraoperative complications occurred in 25.9% in LMIC, in 18.7% in UMIC and in 37.1% in HIC (P < .001). Hospital mortality was 0.0% in LMIC, 1.3% in UMIC and 0.6% in HIC (P = .009).

Conclusion: The risk for and incidence of PPC is higher in LMIC than in UMIC and HIC. Ventilation management could be improved in LMIC and UMIC.

Trial registration: Clinicaltrials.gov , identifier: NCT01601223.

Keywords: ARISCAT score; Geo–economic variation; Intraoperative ventilation; Postoperative pulmonary complications, ventilation, intraoperative ventilation; Ventilator management.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Anesthesia, General / methods*
Developed Countries
Developing Countries
Female
Humans
Incidence
Internationality
Intraoperative Complications / epidemiology*
Length of Stay / statistics & numerical data
Lung Diseases / epidemiology*
Male
Middle Aged
Postoperative Complications / epidemiology*
Poverty / statistics & numerical data*
Respiration, Artificial / statistics & numerical data*
Risk Assessment

Associated data

ClinicalTrials.gov/NCT01601223