Determinants of postoperative complications in high-risk noncardiac surgery patients optimized with hemodynamic treatment strategies: A post-hoc analysis of a randomized multicenter clinical trial - 11/01/24
, Mouhamed Djahoum Moussa, MD c, Richard Descamps, MD d, Younes El Amine, MD e, Belaid Bouhemad, MD, PhD f, g, Marc-Olivier Fischer, MD, PhD h, Emmanuel Lorne, MD, PhD i, Hervé Dupont, MD, PhD a, b, Momar Diouf, PhD j, Pierre Grégoire Guinot, MD, PhD f, gfor the OPHIQUE study group1
Abstract |
Study objective |
This post-hoc analysis of a randomized controlled trial was undertaken to establish the determinants of postoperative complications and acute kidney injury in high-risk noncardiac surgery patients supported with hemodynamic treatment strategies.
Design |
We conducted a post-hoc analysis of patients enrolled in the OPtimization Hemodynamic Individualized by the respiratory QUotiEnt (OPHIQUE) trial.
Setting |
Operating rooms in four university medical centers and one non-university hospital from December 26, 2018, to September 9, 2021.
Patients |
We enrolled 350 patients with a high risk of postoperative complications undergoing high-risk noncardiac surgery lasting 2 h or longer under general anesthesia.
Interventions |
All patients were treated according to hemodynamic treatment strategies which included cardiac output optimization by titration of fluid challenge and targeted systolic blood pressure to remain within ±10% of the reference value.
Measurements |
We assessed the association between pre-operative and intra-operative exposure of interest with a composite primary outcome of major complications or death within seven days following surgery using a multivariable logistic regression model. We also assessed the association between these exposures of interest and acute kidney injury.
Main results |
The data of 341 patients were analyzed. In multivariate analysis, the factors independently associated with the primary outcome were age (OR = 1.04 (1.01–1.06), P = 0.002), preoperative hemoglobin concentration (OR = 0.85 (0.75–0.96), P = 0.012), non-vascular surgery (OR = 0.30 (0.17–0.53), P < 0.0001), and intraoperative surgical complications (OR = 2.08 (1.02–4.24), P = 0.046). The factors independently associated with postoperative acute kidney injury were age (OR = 1.04 (1.01–1.08), P = 0.008), preoperative creatinine concentration (OR = 1.01 (1.00–1.01), P = 0.049), non-vascular surgery (OR = 0.36 (0.20–0.66), P = 0.001), and intraoperative surgical complications (OR = 3.36 (1.50–7.55), P = 0.031).
Conclusions |
Surgical complications, a lower preoperative hemoglobin concentration, age, and vascular surgery were associated with postoperative complications in a high-risk noncardiac surgery population supported with hemodynamic treatment strategies.
Le texte complet de cet article est disponible en PDF.Highlights |
• | The prevalence of complications was high for patients treated according to hemodynamic treatment strategy. |
• | factors associated with complications in this population were age, the preoperative hemoglobin and surgical complications. |
• | These factors were associated with outcome in this population treated according to hemodynamic treatment strategy. |
• | Neither blood pressure, cardiac output, intraoperative volume, nor norepinephrine dose were associated with complications. |
Keywords : Postoperative outcome, Acute kidney injury, Goal directed hemodynamic therapy, Surgical complications
Plan
Vol 93
Article 111325- mai 2024 Retour au numéro
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