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, 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

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.

Conflict of interest statement

The authors declare that they have no competing interests

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Kaplan–Meier curves for postoperative pulmonary complications and hospital mortality. Patients who were lost to follow–up due to hospital discharge were assumed not to have developed PPC
Fig. 2
Fig. 2
Cumulative distribution plots for the median values of the ventilatory parameters during the intraoperative period and stratified by geo–economic group. PBW calculated according to the standard formula. Unadjusted p-value comparing multiple groups. Abbreviations: Tidal volume (VT), Positive End–expiratory Pressure (PEEP), Driving pressure (ΔP) and Fraction inspired oxygen (FiO2) per income group according to the World Bank country classification 2020

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