Ventilation and outcomes following robotic-assisted abdominal surgery: an international, multicentre observational study
Assessment of Ventilation during general AnesThesia for Robotic surgery (AVATaR) Study Investigators, PROtective VEntilation (PROVE) Network, Writing Committee Members, Steering Committee Members, AVATaR Investigators, Veronica N F Queiroz, Luis Guilherme V da Costa, Flavio Takaoka, Paolo Pelosi, Marcelo Gama de Abreu, Marcus J Schultz, Ary Serpa Neto, R P Barbosa, J Canet, J P Cata, D S Cesar, R C F Chaves, U C D'Orto, L G V Da Costa, L De Baerdemaeker, J R Galdi, M Gama de Abreu, V Gottumukkala, S N T Hemmes, M W Hollmann, A F Kalmar, R Mariano, I Matot, G Mazzinari, G H Mills, P Pelosi, I P Posso, V N F Queiroz, M J Schultz, A Serpa Neto, J Sprung, F Takaoka, A Teruya, M F Vidal Melo, Aalok V Agarwala, Louise Akeroyd, Francesco Andorlini, Lisa Anicetti, Massimo Antonelli, Bruno S Arantes, Jose J Ariño Irujo, Hanna Artsi, Renata Babian, Rogerio P Barbosa, Doug Barker, Diletta Basagni, Nicola Basso, Joan Beltran, Vittorio Bocciero, Giulia Bonatti, Ernesto Boriati, Mauro Bravo, Luca Brazzi, Chris Brearton, Andrew Brennan, Adam M Bulinski, Sara Cafagna, Andrea Cardoni, Paula Castelló Mora, Juan P Cata, Daniel S Cesar, Renato Cf Chaves, Lee-Lynn Chen, Srikanth Chukkambotla, Alessandra Ciccozzi, Danae Cilia, Sean Cope, Ulisses C D'Orto, Luis Guilherme V Da Costa, Claire Dalton, Alessandra Davi, Marina Del Barrio De Bonis, Angelo Raffaele De Gaudio, Lucilla De Luca, Carlos C Delgado, Atousa Deljou, Cecilia Di Ruscio, Sijgje M Droger, Stephen Duberley, Leonid A Eidelman, Alison Evans, Constanza Fabiani, Umberto Fasciano, Jennifer Firth-Gieben, Jillian Fitchett, Angela Fundarò, Jose Roberto Galdi, Verdiana Gallo, Mattia Gavagni, Vijaya Gottumukkala, Chris Graham, Manuel Granell Gil, Angelo Gratarola, Chiara Grillandini, Harald-Thomas Groeben, Nesrine Ismail, Reni Jacob, Chris Jones, Rebecca Jones, Alain F Kalmar, Ritoo Kapoor, Leigh Kelliher, Wiebke Köhne, Joseph Sha Koopman, Prasad Lanka, Jae-Woo Lee, Bernard Liban, Francesca Livi, Renato Mariano, Ruth Martinez Plumed, Idit Matot, Marta Mazzella, Stewart McClure, Martina McMonagle, Gary H Mills, Lucia Mirabella, Concepción Monsalve, Angela Moon, Laura Morchio, Frances Morris, Lorenzo Motroni, Benedetta Mura, Alessandro Nerini, Elodia C Noumedem Sonna, Neil Oakes, Marina Orlandi, Antonella Paladini, Anita Patil, Vishal Patil, Valentina Patrone, Paolo Pelosi, Angela Pinder, Alba Piroli, Irimar P Posso, Veronica Nf Queiroz, Yosef S Rabbu, Robert Rabenalt, Stefano Romagnoli, Ariel Ronen, Felipe Rothman, Patrick Rusagara, Andrea Russo, Moldovan Sabov, Thomas Saitta, Ary Serpa Neto, Nirav Shah, Neil Smith, Liliana Sollazzi, Juraj Sprung, Emma Stewart, Elizabeth Stones, Kim Storton, Flavio Takaoka, Beatriz Tena, Eleonora Terreni, Alexandre Teruya, Chiara Travaglia, Tanja A Treschan, Henk Vanoverschelde, Harish Venkatesh, Marcos F Vidal Melo, Gianluca Villa, Robbert Vossen, Stephen Webber, Toby N Weingarten, Matt Willcocks, Luke Winslow, Lindsey Woods, Assessment of Ventilation during general AnesThesia for Robotic surgery (AVATaR) Study Investigators, PROtective VEntilation (PROVE) Network, Writing Committee Members, Steering Committee Members, AVATaR Investigators, Veronica N F Queiroz, Luis Guilherme V da Costa, Flavio Takaoka, Paolo Pelosi, Marcelo Gama de Abreu, Marcus J Schultz, Ary Serpa Neto, R P Barbosa, J Canet, J P Cata, D S Cesar, R C F Chaves, U C D'Orto, L G V Da Costa, L De Baerdemaeker, J R Galdi, M Gama de Abreu, V Gottumukkala, S N T Hemmes, M W Hollmann, A F Kalmar, R Mariano, I Matot, G Mazzinari, G H Mills, P Pelosi, I P Posso, V N F Queiroz, M J Schultz, A Serpa Neto, J Sprung, F Takaoka, A Teruya, M F Vidal Melo, Aalok V Agarwala, Louise Akeroyd, Francesco Andorlini, Lisa Anicetti, Massimo Antonelli, Bruno S Arantes, Jose J Ariño Irujo, Hanna Artsi, Renata Babian, Rogerio P Barbosa, Doug Barker, Diletta Basagni, Nicola Basso, Joan Beltran, Vittorio Bocciero, Giulia Bonatti, Ernesto Boriati, Mauro Bravo, Luca Brazzi, Chris Brearton, Andrew Brennan, Adam M Bulinski, Sara Cafagna, Andrea Cardoni, Paula Castelló Mora, Juan P Cata, Daniel S Cesar, Renato Cf Chaves, Lee-Lynn Chen, Srikanth Chukkambotla, Alessandra Ciccozzi, Danae Cilia, Sean Cope, Ulisses C D'Orto, Luis Guilherme V Da Costa, Claire Dalton, Alessandra Davi, Marina Del Barrio De Bonis, Angelo Raffaele De Gaudio, Lucilla De Luca, Carlos C Delgado, Atousa Deljou, Cecilia Di Ruscio, Sijgje M Droger, Stephen Duberley, Leonid A Eidelman, Alison Evans, Constanza Fabiani, Umberto Fasciano, Jennifer Firth-Gieben, Jillian Fitchett, Angela Fundarò, Jose Roberto Galdi, Verdiana Gallo, Mattia Gavagni, Vijaya Gottumukkala, Chris Graham, Manuel Granell Gil, Angelo Gratarola, Chiara Grillandini, Harald-Thomas Groeben, Nesrine Ismail, Reni Jacob, Chris Jones, Rebecca Jones, Alain F Kalmar, Ritoo Kapoor, Leigh Kelliher, Wiebke Köhne, Joseph Sha Koopman, Prasad Lanka, Jae-Woo Lee, Bernard Liban, Francesca Livi, Renato Mariano, Ruth Martinez Plumed, Idit Matot, Marta Mazzella, Stewart McClure, Martina McMonagle, Gary H Mills, Lucia Mirabella, Concepción Monsalve, Angela Moon, Laura Morchio, Frances Morris, Lorenzo Motroni, Benedetta Mura, Alessandro Nerini, Elodia C Noumedem Sonna, Neil Oakes, Marina Orlandi, Antonella Paladini, Anita Patil, Vishal Patil, Valentina Patrone, Paolo Pelosi, Angela Pinder, Alba Piroli, Irimar P Posso, Veronica Nf Queiroz, Yosef S Rabbu, Robert Rabenalt, Stefano Romagnoli, Ariel Ronen, Felipe Rothman, Patrick Rusagara, Andrea Russo, Moldovan Sabov, Thomas Saitta, Ary Serpa Neto, Nirav Shah, Neil Smith, Liliana Sollazzi, Juraj Sprung, Emma Stewart, Elizabeth Stones, Kim Storton, Flavio Takaoka, Beatriz Tena, Eleonora Terreni, Alexandre Teruya, Chiara Travaglia, Tanja A Treschan, Henk Vanoverschelde, Harish Venkatesh, Marcos F Vidal Melo, Gianluca Villa, Robbert Vossen, Stephen Webber, Toby N Weingarten, Matt Willcocks, Luke Winslow, Lindsey Woods
Abstract
Background: International data on the epidemiology, ventilation practice, and outcomes in patients undergoing abdominal robotic-assisted surgery (RAS) are lacking. The aim of the study was to assess the incidence of postoperative pulmonary complications (PPCs), and to describe ventilator management after abdominal RAS.
Methods: This was an international, multicentre, prospective study in 34 centres in nine countries. Patients ≥18 yr of age undergoing abdominal RAS were enrolled between April 2017 and March 2019. The Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score was used to stratify for higher risk of PPCs (≥26). The primary outcome was the incidence of PPCs. Secondary endpoints included the preoperative risk for PPCs and ventilator management.
Results: Of 1167 subjects screened, 905 abdominal RAS patients were included. Overall, 590 (65.2%) patients were at increased risk for PPCs. Meanwhile, 172 (19%) patients sustained PPCs, which occurred more frequently in 132 (22.4%) patients at increased risk, compared with 40 (12.7%) patients at lower risk of PPCs (absolute risk difference: 12.2% [95% confidence intervals (CI), 6.8-17.6%]; P<0.001). Plateau and driving pressures were higher in patients at increased risk, compared with patients at low risk of PPCs, but no ventilatory variables were independently associated with increased occurrence of PPCs. Development of PPCs was associated with a longer hospital stay.
Conclusions: One in five patients developed one or more PPCs (chiefly unplanned oxygen requirement), which was associated with a longer hospital stay. No ventilatory variables were independently associated with PPCs.
Clinical trial registration: NCT02989415.
Keywords: abdominal surgery; intraoperative ventilation; postoperative pulmonary complications; robotic surgery; robotic-assisted surgery.
Copyright © 2020 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.
Source: PubMed