TY - JOUR
T1 - Ventilation and outcomes following robotic-assisted abdominal surgery
T2 - an international, multicentre observational study
AU - Assessment of Ventilation during general AnesThesia for Robotic surgery (AVATaR)
AU - Study Investigators
AU - for the PROtective VEntilation (PROVE) Network
AU - Serpa Neto, Ary
AU - Study group members AMC, null
AU - Schultz, Marcus J.
AU - Hollmann, Markus W.
N1 - Funding Information: We are indebted to all multidisciplinary team members at the study sites for their enthusiastic support and for diligently following the study interventions in the original trials. We also thank the consultant surgeons for their support with this study, which took place at the Kent & Canterbury Hospital (EKHUFT): Ben Eddy, Edward Streeter, Sashi Kommu, and Milan Thomas; and the Clinical Research Facility, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust. Funding Information: Hospital Israelita Albert Einstein. The study was supported in the UK by a grant from the Association of Anaesthetists of Great Britain & Ireland (AAGBI)/Northern Ireland Society of Anaesthetists (NIAA) (NIAAGC/06.2017/6). The funding source had no role in the conduct of the present study or previous trials; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Publisher Copyright: © 2020 British Journal of Anaesthesia Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/2
Y1 - 2021/2
N2 - 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.
AB - 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.
KW - abdominal surgery
KW - intraoperative ventilation
KW - postoperative pulmonary complications
KW - robotic surgery
KW - robotic-assisted surgery
UR - http://www.scopus.com/inward/record.url?scp=85094836948&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.bja.2020.08.058
DO - https://doi.org/10.1016/j.bja.2020.08.058
M3 - Article
C2 - 33131757
SN - 0007-0912
VL - 126
SP - 533
EP - 543
JO - British Journal of Anaesthesia
JF - British Journal of Anaesthesia
IS - 2
ER -