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Sex Difference and intra-operative tidal volume: Insights&nbsp

Background It is uncertain whether the association of the intraoperative driving pressure (Delta P) with postoperative pulmonary complications (PPCs) depends on the surgical approach during abdominal surgery. Our primary objective was to determine and compare the association of time-weighted average Delta P (Delta P-TW) with PPCs. We also tested the association of Delta P-TW with intraoperative adverse events. Methods Posthoc retrospective propensity score-weighted cohort analysis of patients undergoing open or closed abdominal surgery in the 'Local ASsessment of Ventilatory management during General Anaesthesia for Surgery' (LAS VEGAS) study, that included patients in 146 hospitals across 29 countries. The primary endpoint was a composite of PPCs. The secondary endpoint was a composite of intraoperative adverse events. Results The analysis included 1128 and 906 patients undergoing open or closed abdominal surgery, respectively. The PPC rate was 5%. Delta P was lower in open abdominal surgery patients, but Delta P-TW was not different between groups. The association of Delta P-TW with PPCs was significant in both groups and had a higher risk ratio in closed compared to open abdominal surgery patients (1.11 [95%CI 1.10 to 1.20], P < 0.001 versus 1.05 [95%CI 1.05 to 1.05], P < 0.001; risk difference 0.05 [95%CI 0.04 to 0.06], P < 0.001). The association of Delta P-TW with intraoperative adverse events was also significant in both groups but had higher odds ratio in closed compared to open abdominal surgery patients (1.13 [95%CI 1.12- to 1.14], P < 0.001 versus 1.07 [95%CI 1.05 to 1.10], P < 0.001; risk difference 0.05 [95%CI 0.030.07], P < 0.001).Conclusions Delta P is associated with PPC and intraoperative adverse events in abdominal surgery, both in open and closed abdominal surgery.Trial registrationLAS VEGAS was registered at clinicaltrials.gov (trial identifier NCT01601223).

Background - Patients’ demographic and epidemiological characteristics,local variations in clinicians’ knowledge and experience and types of surgerycan influence peri-operative transfusion practices. Sharing data on transfusionpractices and recipients may improve patients’ care and implementation ofPatient Blood Management (PBM).Materials and methods - This was a multicentre, prospective, observational,cross-sectional study that included 61 centres. Clinical and transfusion dataof patients undergoing major elective surgery were collected; transfusionpredictors and patients’ outcomes were analysed.Results - Of 6,121 patients, 1,579 (25.8%) received a peri-operative transfusion.A total of 5,812 blood components were transfused: red blood cells (RBC),fresh-frozen plasma and platelets in 1,425 (23.3%), 762 (12.4%) and 88(1.4%) cases, respectively). Pre-operative anaemia was identified in 2,019(33%) patients. Half of the RBC units were used by patients in the age group45-69 years. Specific procedures with the highest RBC use were coronaryartery bypass grafting (16.9% of all units) and hip arthroplasty (14.9%).Low haemoglobin concentration was the most common indication forintra-operative RBC transfusion (57%) and plasma and platelet transfusionswere mostly initiated for acute bleeding (61.3% and 61.1%, respectively).The RBC transfusion rate in study centres varied from 2% to 72%. RBCtransfusion was inappropriate in 99% (n=150/151) of pre-operative, 23%(n=211/926) of intra-operative and 43% (n=308/716) of post-operative RBCtransfusion episodes. Pre-operative haemoglobin, increased blood loss, opensurgery and duration of surgery were the main independent predictors ofintra-operative RBC transfusion. Low pre-operative haemoglobinconcentration was independently associated with post-operative pulmonarycomplications.Conclusions - These findings identified areas for improvement inperi-operative transfusion practice and PBM implementation in Turkey.Keywords: Blood components, patient blood management, peri-operative, transfusion

İntraoperative Ventilator Settings and their Association With Postoperative Pulmonary Complications in Neurosurgical Patients:Post-hoc Analysis of LASVEGAS Study.

Altmış Beş Yaş Üst Ortopedi Alt Ekstremite Cerrahisi Hastalarında Möroaksiyel Blok Öncesinde Ultrasonografi Eşliğinde İşaretlemenin Blok Başarısına Etkisi