Details

Autor(en) / Beteiligte

• Takeda, Chikashi
• Takeuchi, Masato
• Mizota, Toshiyuki
• Yonekura, Hiroshi
• Nahara, Isao
• Joo, Woo J.
• Dong, Li
• Kawasaki, Yohei
• Kawakami, Koji

Titel

The association between arterial pulse waveform analysis device and in‐hospital mortality in high‐risk non‐cardiac surgeries

Ist Teil von

• Acta anaesthesiologica Scandinavica, 2020-08, Vol.64 (7), p.928-935

Ort / Verlag

England: Wiley Subscription Services, Inc

Erscheinungsjahr

2020

Quelle

Wiley Blackwell Single Titles

Beschreibungen/Notizen

• Background Perioperative goal‐directed fluid therapy is used for haemodynamic optimization in high‐risk surgeries. Cardiac output monitoring can be performed by a specialized pressure transducer for arterial pulse waveform analysis (S‐APWA). No study has assessed whether real‐world use of S‐APWA is associated with post‐operative outcomes; therefore, using a Japanese administrative claims database, we retrospectively investigated whether S‐APWA use is associated with in‐hospital mortality among patients undergoing high‐risk surgery under general anaesthesia. Methods Adult patients who underwent high‐risk surgery under general anaesthesia and arterial catheterization between 2014 and 2016 were divided into S‐APWA and conventional arterial pressure transducer groups, then compared regarding baseline factors and outcomes. Logistic regression analysis was performed to compare in‐hospital mortality. Subgroup analyses evaluated S‐APWA efficacy and outcomes based on the type of surgery and patients’ comorbidity. Results S‐APWA was used in 6859 of 23 655 (29.0%) patients; the crude in‐hospital mortality rate was 3.5%. Adjusted analysis showed no significant association between S‐APWA use and in‐hospital mortality rate (adjusted odds ratio [aOR] = 0.91; 95% confidence interval [CI]: 0.76‐1.07; P = .25). S‐APWA use was associated with significantly lower in‐hospital mortality in patients undergoing vascular surgery (aOR = 0.67; 95% CI: 0.49‐0.94), and significantly higher in‐hospital mortality in patients undergoing lower limb amputation (aOR = 2.63; 95% CI: 1.32‐5.22). S‐APWA use and in‐hospital mortality were not significantly associated with other subgroups. Conclusion S‐APWA use was not associated with in‐hospital mortality in the entire study population. However, S‐APWA was associated with decreased in‐hospital mortality among vascular surgery and increased in‐hospital mortality among lower limb amputation.