Show simple item record

Oxygen administration during surgery and postoperative organ injury: observational cohort study

dc.contributor.authorMcIlroy, David R
dc.contributor.authorShotwell, Matthew S
dc.contributor.authorLopez, Marcos G
dc.contributor.authorVaughn, Michelle T
dc.contributor.authorOlsen, Joanna S
dc.contributor.authorHennessy, Cassandra
dc.contributor.authorWanderer, Jonathan P
dc.contributor.authorSemler, Matthew S
dc.contributor.authorRice, Todd W
dc.contributor.authorKheterpal, Sachin
dc.contributor.authorBillings IV, Frederic T
dc.contributor.authoron behalf of the Multicenter Perioperative Outcomes Group
dc.date.accessioned2023-03-01T20:10:28Z
dc.date.available2023-03-01T20:10:28Z
dc.date.issued2022-11-30
dc.identifier.citationBMJ 2022;379:e070941 http://dx.doi.org/10.1136/ bmj-2022-070941en_US
dc.identifier.issn0959-535X
dc.identifier.othereISSN : 1756-1833
dc.identifier.urihttp://hdl.handle.net/1803/18043
dc.description.abstractObjective To examine whether supraphysiological oxygen administration during surgery is associated with lower or higher postoperative kidney, heart, and lung injury. Design Observational cohort study. Setting 42 medical centers across the United States participating in the Multicenter Perioperative Outcomes Group data registry. Participants Adult patients undergoing surgical procedures >= 120 minutes' duration with general anesthesia and endotracheal intubation who were admitted to hospital after surgery between January 2016 and November 2018. Intervention Supraphysiological oxygen administration, defined as the area under the curve of the fraction of inspired oxygen above air (21%) during minutes when the hemoglobin oxygen saturation was greater than 92%. Main outcomes Primary endpoints were acute kidney injury defined using Kidney Disease Improving Global Outcomes criteria, myocardial injury defined as serum troponin >0.04 ng/mL within 72 hours of surgery, and lung injury defined using international classification of diseases hospital discharge diagnosis codes. Results The cohort comprised 350 647 patients with median age 59 years (interquartile range 46-69 years), 180 546 women (51.5%), and median duration of surgery 205 minutes (interquartile range 158-279 minutes). Acute kidney injury was diagnosed in 19 207 of 297 554 patients (6.5%), myocardial injury in 8972 of 320 527 (2.8%), and lung injury in 13 789 of 312 161 (4.4%). The median fraction of inspired oxygen was 54.0% (interquartile range 47.5%-60.0%), and the area under the curve of supraphysiological inspired oxygen was 7951% min (5870-11 107% min), equivalent to an 80% fraction of inspired oxygen throughout a 135 minute procedure, for example. After accounting for baseline covariates and other potential confounding variables, increased oxygen exposure was associated with a higher risk of acute kidney injury, myocardial injury, and lung injury. Patients at the 75th centile for the area under the curve of the fraction of inspired oxygen had 26% greater odds of acute kidney injury (95% confidence interval 22% to 30%), 12% greater odds of myocardial injury (7% to 17%), and 14% greater odds of lung injury (12% to 16%) compared with patients at the 25th centile. Sensitivity analyses evaluating alternative definitions of the exposure, restricting the cohort, and conducting an instrumental variable analysis confirmed these observations. Conclusions Increased supraphysiological oxygen administration during surgery was associated with a higher incidence of kidney, myocardial, and lung injury. Residual confounding of these associations cannot be excluded.en_US
dc.description.sponsorshipMGL received funding from United States National Institutes of Health (NIH) grant K23GM129662. MWSe received funding from NIH grant K23HL143053. FTB received funding from NIH grants R01GM112871 and R35GM145375 and an Association of University Anesthesiologists' IMPACT award specific to this study. Funding was also provided by departmental and institutional resources at each contributing medical center. Funding to support underlying electronic health record data collection into the Multicenter Perioperative Outcomes Group registry was provided by Blue Cross Blue Shield of Michigan/Blue Care Network as part of the Blue Cross Blue Shield of Michigan/Blue Care Network Value Partnerships program. Although Blue Cross Blue Shield of Michigan/Blue Care Network and Multicenter Perioperative Outcomes Group work collaboratively, the opinions, beliefs and viewpoints expressed by the authors do not necessarily reflect the opinions, beliefs, and viewpoints of Blue Cross Blue Shield of Michigan/Blue Care Network or any of its employees. The funders had no role in considering the study design or in the collection, analysis, interpretation of data, writing of the report, or decision to submit the article for publication.en_US
dc.language.isoen_USen_US
dc.publisherBmj-british Medical Journalen_US
dc.rightsThis article is available under the Creative Commons CC-BY-NC 4.0 license and permits non-commercial use, distribution and reproduction in any medium, provided the original work is properly cited.
dc.source.urihttps://www.bmj.com/content/379/bmj-2022-070941
dc.titleOxygen administration during surgery and postoperative organ injury: observational cohort studyen_US
dc.typeArticleen_US
dc.identifier.doi10.1136/bmj-2022-070941


Files in this item

Icon

This item appears in the following Collection(s)

Show simple item record