Sex dependence of postoperative pulmonary complications – A post hoc unmatched and matched analysis of LAS VEGAS

IF 5 2区医学 Q1 ANESTHESIOLOGY Journal of Clinical Anesthesia Pub Date : 2024-09-23 DOI:10.1016/j.jclinane.2024.111565

Tom D. Vermeulen MD , Liselotte Hol MD , Pien Swart BSc , Michael Hiesmayr MD, PhD , Gary H. Mills MD, PhD , Christian Putensen MD, PhD , Werner Schmid MD, PhD , Ary Serpa Neto MD, PhD , Paolo Severgnini MD, PhD , Marcos F. Vidal Melo MD, PhD , Hermann Wrigge MD, PhD , Markus W. Hollmann MD, PhD , Marcelo Gama de Abreu MD, PhD , Marcus J. Schultz MD, PhD , Sabrine N. Hemmes MD, PhD , David M. van Meenen MD, PhD

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Abstract

Study objective

Male sex has inconsistently been associated with the development of postoperative pulmonary complications (PPCs). These studies were different in size, design, population and preoperative risk. We reanalysed the database of ‘Local ASsessment of Ventilatory management during General Anaesthesia for Surgery study’ (LAS VEGAS) to evaluate differences between females and males with respect to PPCs.

Design, setting and patients

Post hoc unmatched and matched analysis of LAS VEGAS, an international observational study in patients undergoing intraoperative ventilation under general anaesthesia for surgery in 146 hospitals across 29 countries. The primary endpoint was a composite of PPCs in the first 5 postoperative days. Individual PPCs, hospital length of stay and mortality were secondary endpoints. Propensity score matching was used to create a similar cohort regarding type of surgery and epidemiological factors with a known association with development of PPCs.

Main results

The unmatched cohort consisted of 9697 patients; 5342 (55.1%) females and 4355 (44.9%) males. The matched cohort consisted of 6154 patients; 3077 (50.0%) females and 3077 (50.0%) males. The incidence in PPCs was neither significant between females and males in the unmatched cohort (10.0 vs 10.7%; odds ratio (OR) 0.93 [0.81–1.06]; P = 0.255), nor in the matched cohort (10.5 vs 10.0%; OR 1.05 [0.89–1.25]; P = 0.556). New invasive ventilation occurred less often in females in the unmatched cohort. Hospital length of stay and mortality were similar between females and males in both cohorts.

Conclusions

In this conveniently–sized worldwide cohort of patients receiving intraoperative ventilation under general anaesthesia for surgery, the PPC incidence was not significantly different between sexes.

Registration

LAS VEGAS was registered at clinicaltrial.gov (study identifier NCT01601223).

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术后肺部并发症的性别依赖性 - LAS VEGAS 的非匹配和匹配后分析

研究目的男性性别与术后肺部并发症（PPCs）的发生相关性并不一致。这些研究在规模、设计、人群和术前风险方面都不尽相同。我们重新分析了 "手术全身麻醉期间通气管理本地评估研究"（LAS VEGAS）的数据库，以评估女性和男性在肺部并发症方面的差异。设计、环境和患者LAS VEGAS是一项国际观察性研究，对象是在29个国家的146家医院接受手术全身麻醉下术中通气的患者。主要终点是术后前 5 天的 PPCs 综合指数。单个 PPCs、住院时间和死亡率是次要终点。主要结果未匹配队列由9697名患者组成，其中女性5342人（55.1%），男性4355人（44.9%）。匹配队列由 6154 名患者组成，其中女性 3077 人（50.0%），男性 3077 人（50.0%）。在非匹配队列（10.0 vs 10.7%；比值比 (OR) 0.93 [0.81-1.06]；P = 0.255）和匹配队列（10.5 vs 10.0%；OR 1.05 [0.89-1.25]；P = 0.556）中，女性和男性之间的 PPC 发生率差异不大。在非配对队列中，女性较少发生新的有创通气。结论在这个规模庞大的全球队列中，在全身麻醉下接受术中通气治疗的患者中，PPC的发生率在性别上没有明显差异。注册LAS VEGAS已在clinicaltrial.gov网站注册（研究标识符为NCT01601223）。

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.