Wang Tianzhu, Zhao Weixing, Ma Libin, Wu Jing, Ma Xiaojing, Liu Luyu, Cao Jiangbei, Lou Jingsheng, Mi Weidong, Zhang Changsheng
Department of Anesthesia, First Medical Centre of Chinese PLA General Hospital, Beijing, China.
National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China.
Front Physiol. 2024 Oct 18;15:1471454. doi: 10.3389/fphys.2024.1471454. eCollection 2024.
The ideal intra-operative inspired oxygen concentration remains controversial. We aimed to investigate the association between the intraoperative fraction of inspired oxygen (FiO) and the incidence of postoperative pulmonary complications (PPCs) in patients undergoing non-cardiothoracic surgery.
This was a retrospective cohort study of elderly patients who underwent non-cardiothoracic surgery between April 2020 and January 2022. According to intraoperative FiO, patients were divided into low (≤60%) and high (>60%) FiO groups. The primary outcome was the incidence of a composite of pulmonary complications (PPCs) within the first seven postoperative days. Propensity score matching (PSM) and inverse probability treatment weighting (IPTW) were conducted to adjust for baseline characteristic differences between the two groups. Multivariate logistic regression analysis was used to calculate the odds ratios (OR) for FiO and PPCs.
Among the 3,515 included patients with a median age of 70 years (interquartile range: 68-74), 492 (14%) experienced PPCs within the first 7 postoperative days. Elevated FiO was associated with an increased risk of PPCs in all the logistic regression models. The OR of the FiO > 60% group was 1.252 (95%CI, 1.015-1.551, P = 0.038) in the univariate analysis. In the multivariate logistic regression models, the ORs of the FiO > 60% group were 1.259 (Model 2), 1.314 (Model 3), and 1.32 (model 4). A balanced covariate distribution between the two groups was created using PSM or IPTW. The correlation between elevated FiO and an increased risk of PPCs remained statistically significant with PSM analysis (OR, 1.393; 95% CI, 1.077-1.804; P = 0.012) and IPTW analysis (OR, 1.266; 95% CI, 1.086-1.476; P = 0.003).
High intraoperative FiO (>60%) was associated with the postoperative occurrence of pulmonary complications, independent of predefined risk factors, in elderly non-cardiothoracic surgery patients. High intraoperative FiO should be applied cautiously in surgical patients vulnerable to PPCs.
理想的术中吸入氧浓度仍存在争议。我们旨在研究非心胸外科手术患者术中吸入氧分数（FiO₂）与术后肺部并发症（PPCs）发生率之间的关联。
这是一项对2020年4月至2022年1月期间接受非心胸外科手术的老年患者进行的回顾性队列研究。根据术中FiO₂，患者被分为低FiO₂（≤60%）组和高FiO₂（>60%）组。主要结局是术后前7天内肺部并发症（PPCs）综合发生率。采用倾向评分匹配（PSM）和逆概率处理加权（IPTW）来调整两组之间的基线特征差异。多因素逻辑回归分析用于计算FiO₂与PPCs的比值比（OR）。
在纳入的3515例患者中，中位年龄为70岁（四分位间距：68 - 74岁），492例（14%）在术后前7天内发生了PPCs。在所有逻辑回归模型中，FiO₂升高与PPCs风险增加相关。单因素分析中，FiO₂>60%组的OR为1.252（95%CI，1.015 - 1.551，P = 0.038）。在多因素逻辑回归模型中，FiO₂>60%组的OR分别为1.259（模型2）、1.314（模型3）和1.32（模型4）。使用PSM或IPTW在两组之间创建了平衡的协变量分布。PSM分析（OR，1.393；95%CI，1.077 - 1.804；P = 0.012）和IPTW分析（OR，1.266；95%CI，1.086 - 1.476；P = 0.003）显示，FiO₂升高与PPCs风险增加之间的相关性在统计学上仍具有显著性。
在老年非心胸外科手术患者中，术中高FiO₂（>60%）与术后肺部并发症的发生相关，且独立于预先定义的风险因素。对于易发生PPCs的手术患者，应谨慎应用术中高FiO₂。
