Outcomes and risk factors for delayed-onset postoperative respiratory failure: a multi-center case-control study by the University of California Critical Care Research Collaborative (UC3RC)
Abstract Background Few interventions are known to reduce the incidence of respiratory failure that occurs following elective surgery (postoperative respiratory failure; PRF). We previously reported risk factors associated with PRF that occurs within the first 5 days after elective surgery (early PR...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-05-01
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| Series: | BMC Anesthesiology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12871-022-01681-x |
| _version_ | 1811235491425550336 |
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| author | Jacqueline C. Stocking Christiana Drake J. Matthew Aldrich Michael K. Ong Alpesh Amin Rebecca A. Marmor Laura Godat Maxime Cannesson Michael A. Gropper Patrick S. Romano Christian Sandrock Christian Bime Ivo Abraham Garth H. Utter |
| author_facet | Jacqueline C. Stocking Christiana Drake J. Matthew Aldrich Michael K. Ong Alpesh Amin Rebecca A. Marmor Laura Godat Maxime Cannesson Michael A. Gropper Patrick S. Romano Christian Sandrock Christian Bime Ivo Abraham Garth H. Utter |
| author_sort | Jacqueline C. Stocking |
| collection | DOAJ |
| description | Abstract Background Few interventions are known to reduce the incidence of respiratory failure that occurs following elective surgery (postoperative respiratory failure; PRF). We previously reported risk factors associated with PRF that occurs within the first 5 days after elective surgery (early PRF; E-PRF); however, PRF that occurs six or more days after elective surgery (late PRF; L-PRF) likely represents a different entity. We hypothesized that L-PRF would be associated with worse outcomes and different risk factors than E-PRF. Methods This was a retrospective matched case-control study of 59,073 consecutive adult patients admitted for elective non-cardiac and non-pulmonary surgical procedures at one of five University of California academic medical centers between October 2012 and September 2015. We identified patients with L-PRF, confirmed by surgeon and intensivist subject matter expert review, and matched them 1:1 to patients who did not develop PRF (No-PRF) based on hospital, age, and surgical procedure. We then analyzed risk factors and outcomes associated with L-PRF compared to E-PRF and No-PRF. Results Among 95 patients with L-PRF, 50.5% were female, 71.6% white, 27.4% Hispanic, and 53.7% Medicare recipients; the median age was 63 years (IQR 56, 70). Compared to 95 matched patients with No-PRF and 319 patients who developed E-PRF, L-PRF was associated with higher morbidity and mortality, longer hospital and intensive care unit length of stay, and increased costs. Compared to No-PRF, factors associated with L-PRF included: preexisiting neurologic disease (OR 4.36, 95% CI 1.81–10.46), anesthesia duration per hour (OR 1.22, 95% CI 1.04–1.44), and maximum intraoperative peak inspiratory pressure per cm H20 (OR 1.14, 95% CI 1.06–1.22). Conclusions We identified that pre-existing neurologic disease, longer duration of anesthesia, and greater maximum intraoperative peak inspiratory pressures were associated with respiratory failure that developed six or more days after elective surgery in adult patients (L-PRF). Interventions targeting these factors may be worthy of future evaluation. |
| first_indexed | 2024-04-12T11:52:42Z |
| format | Article |
| id | doaj.art-93799ea889944c3c815c3c63aff75f98 |
| institution | Directory Open Access Journal |
| issn | 1471-2253 |
| language | English |
| last_indexed | 2024-04-12T11:52:42Z |
| publishDate | 2022-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Anesthesiology |
| spelling | doaj.art-93799ea889944c3c815c3c63aff75f982022-12-22T03:34:08ZengBMCBMC Anesthesiology1471-22532022-05-0122111210.1186/s12871-022-01681-xOutcomes and risk factors for delayed-onset postoperative respiratory failure: a multi-center case-control study by the University of California Critical Care Research Collaborative (UC3RC)Jacqueline C. Stocking0Christiana Drake1J. Matthew Aldrich2Michael K. Ong3Alpesh Amin4Rebecca A. Marmor5Laura Godat6Maxime Cannesson7Michael A. Gropper8Patrick S. Romano9Christian Sandrock10Christian Bime11Ivo Abraham12Garth H. Utter13Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of California DavisDepartment of Statistics, University of California DavisDepartment of Anesthesia and Perioperative Care, University of California San FranciscoDepartment of Medicine, University of California Los AngelesDepartment of Medicine, University of California IrvineDepartment of Surgery, University of California San DiegoDepartment of Surgery, University of California San DiegoDepartment of Anesthesiology and Perioperative Medicine, University of California Los AngelesDepartment of Anesthesia and Perioperative Care, University of California San FranciscoDepartment of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of California DavisDepartment of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of California DavisCollege of Medicine, University of Arizona Health SciencesCenter for Health Outcomes and PharmacoEconomic Research, University of ArizonaCenter for Healthcare Policy and Research, University of California DavisAbstract Background Few interventions are known to reduce the incidence of respiratory failure that occurs following elective surgery (postoperative respiratory failure; PRF). We previously reported risk factors associated with PRF that occurs within the first 5 days after elective surgery (early PRF; E-PRF); however, PRF that occurs six or more days after elective surgery (late PRF; L-PRF) likely represents a different entity. We hypothesized that L-PRF would be associated with worse outcomes and different risk factors than E-PRF. Methods This was a retrospective matched case-control study of 59,073 consecutive adult patients admitted for elective non-cardiac and non-pulmonary surgical procedures at one of five University of California academic medical centers between October 2012 and September 2015. We identified patients with L-PRF, confirmed by surgeon and intensivist subject matter expert review, and matched them 1:1 to patients who did not develop PRF (No-PRF) based on hospital, age, and surgical procedure. We then analyzed risk factors and outcomes associated with L-PRF compared to E-PRF and No-PRF. Results Among 95 patients with L-PRF, 50.5% were female, 71.6% white, 27.4% Hispanic, and 53.7% Medicare recipients; the median age was 63 years (IQR 56, 70). Compared to 95 matched patients with No-PRF and 319 patients who developed E-PRF, L-PRF was associated with higher morbidity and mortality, longer hospital and intensive care unit length of stay, and increased costs. Compared to No-PRF, factors associated with L-PRF included: preexisiting neurologic disease (OR 4.36, 95% CI 1.81–10.46), anesthesia duration per hour (OR 1.22, 95% CI 1.04–1.44), and maximum intraoperative peak inspiratory pressure per cm H20 (OR 1.14, 95% CI 1.06–1.22). Conclusions We identified that pre-existing neurologic disease, longer duration of anesthesia, and greater maximum intraoperative peak inspiratory pressures were associated with respiratory failure that developed six or more days after elective surgery in adult patients (L-PRF). Interventions targeting these factors may be worthy of future evaluation.https://doi.org/10.1186/s12871-022-01681-xRespiratory failurePostoperativeRisk factorsSurgical outcomesElective surgeryMatched case-control study, AHRQ PSI 11 |
| spellingShingle | Jacqueline C. Stocking Christiana Drake J. Matthew Aldrich Michael K. Ong Alpesh Amin Rebecca A. Marmor Laura Godat Maxime Cannesson Michael A. Gropper Patrick S. Romano Christian Sandrock Christian Bime Ivo Abraham Garth H. Utter Outcomes and risk factors for delayed-onset postoperative respiratory failure: a multi-center case-control study by the University of California Critical Care Research Collaborative (UC3RC) BMC Anesthesiology Respiratory failure Postoperative Risk factors Surgical outcomes Elective surgery Matched case-control study, AHRQ PSI 11 |
| title | Outcomes and risk factors for delayed-onset postoperative respiratory failure: a multi-center case-control study by the University of California Critical Care Research Collaborative (UC3RC) |
| title_full | Outcomes and risk factors for delayed-onset postoperative respiratory failure: a multi-center case-control study by the University of California Critical Care Research Collaborative (UC3RC) |
| title_fullStr | Outcomes and risk factors for delayed-onset postoperative respiratory failure: a multi-center case-control study by the University of California Critical Care Research Collaborative (UC3RC) |
| title_full_unstemmed | Outcomes and risk factors for delayed-onset postoperative respiratory failure: a multi-center case-control study by the University of California Critical Care Research Collaborative (UC3RC) |
| title_short | Outcomes and risk factors for delayed-onset postoperative respiratory failure: a multi-center case-control study by the University of California Critical Care Research Collaborative (UC3RC) |
| title_sort | outcomes and risk factors for delayed onset postoperative respiratory failure a multi center case control study by the university of california critical care research collaborative uc3rc |
| topic | Respiratory failure Postoperative Risk factors Surgical outcomes Elective surgery Matched case-control study, AHRQ PSI 11 |
| url | https://doi.org/10.1186/s12871-022-01681-x |
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