Department of Anaesthesiology and Pain Medicine, Hyogo Medical University School of Medicine, Nishinomiya, Japan.
Department of Anaesthesiology and Reanimatology, Faculty of Medicine Sciences, University of Fukui, Fukui, Japan.
Interact Cardiovasc Thorac Surg. 2022 Nov 8;35(6). doi: 10.1093/icvts/ivac258.
Since postoperative complications, defined as Clavien-Dindo grade ≥II, correlate with long-term survival after lung resection surgery in patients with primary lung cancer, identification of intraoperative risk factors for postoperative complications is crucial for better perioperative management. In the present study, we investigated the possible association between intraoperative variables for use in anaesthetic management and Clavien-Dindo grade ≥II.
In this multi-institutional observational study, consecutive adult patients undergoing video-assisted thoracic surgery for primary lung cancer under general anaesthesia from March 2019 to April 2021 were enrolled. All patients were divided into 2 groups with Clavien-Dindo grade <II and ≥II. Uni- and multivariable analyses were performed to identify intraoperative risk factors.
After univariable analysis between patients with Clavien-Dindo grade <II (n = 415) and ≥II (n = 121), multivariable analysis revealed higher averaged nociceptive response (NR) index during surgery (mean NR), male sex, lower body mass index, longer duration of surgery, higher blood loss and lower urine volume, as independent risk factors for postoperative complications. In sensitivity analysis, based on the cut-off value of mean NR for postoperative complications, all patients were divided into high and low mean NR groups. The incidence of postoperative complications was significantly higher in patients with high mean NR (n = 332) than in patients with low mean NR (n = 204; P < 0.001).
Higher mean NR, as intraoperative variables for use in anaesthetic management, is associated with the higher incidence of postoperative complications after primary lung cancer surgery.
由于术后并发症（定义为 Clavien-Dindo 分级≥II 级）与原发性肺癌患者肺切除术后的长期生存相关，因此识别围手术期与术后并发症相关的术中危险因素对于更好的围手术期管理至关重要。在本研究中，我们研究了麻醉管理中术中变量与 Clavien-Dindo 分级≥II 级之间可能存在的关联。
本多中心观察性研究纳入了 2019 年 3 月至 2021 年 4 月期间在全身麻醉下接受电视辅助胸腔镜手术治疗原发性肺癌的连续成年患者。所有患者均分为 Clavien-Dindo 分级<II 级（n=415）和≥II 级（n=121）组。进行单变量和多变量分析以确定术中危险因素。
在 Clavien-Dindo 分级<II 级（n=415）和≥II 级（n=121）患者之间进行单变量分析后，多变量分析显示术中平均伤害性反应（NR）指数较高（平均 NR）、男性、较低的体重指数、手术时间较长、术中出血量较大、尿量较低，是术后并发症的独立危险因素。在敏感性分析中，基于术后并发症的平均 NR 截断值，将所有患者分为高平均 NR 和低平均 NR 组。高平均 NR 组（n=332）术后并发症发生率明显高于低平均 NR 组（n=204；P<0.001）。
作为麻醉管理中术中变量的平均 NR 较高，与原发性肺癌手术后术后并发症的发生率较高相关。
