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Postoperative pulmonary complications with adjuvant regional anesthesia versus general anesthesia alone: a sub-analysis of the Perioperative Research Network study

Bartels, Karsten; Frendl, Gyorgy; Sprung, Juraj; Weingarten, Toby N.; Subramaniam, Balachundhar; Martinez Ruiz, Ricardo; Lee, Jae-Woo; Henderson, William G.; Moss, Angela; Sodickson, Alissa; Giquel, Jadelis; Vidal Melo, Marcos F.; Fernandez-Bustamante, Ana

Background
Adjuvant regional anesthesia is often selected for patients or procedures with high risk of pulmonary complications after general anesthesia. The benefit of adjuvant regional anesthesia to reduce postoperative pulmonary complications remains uncertain. In a prospective observational multicenter study, patients scheduled for non-cardiothoracic surgery with at least one postoperative pulmonary complication surprisingly received adjuvant regional anesthesia more frequently than those with no complications. We hypothesized that, after adjusting for surgical and patient complexity variables, the incidence of postoperative pulmonary complications would not be associated with adjuvant regional anesthesia.
Methods
We performed a secondary analysis of a prospective observational multicenter study including 1202 American Society of Anesthesiologists physical status 3 patients undergoing non-cardiothoracic surgery. Patients were classified as receiving either adjuvant regional anesthesia or general anesthesia alone. Predefined pulmonary complications within the first seven postoperative days were prospectively identified. Groups were compared using bivariable and multivariable hierarchical logistic regression analyses for the outcome of at least one postoperative pulmonary complication.
Results
Adjuvant regional anesthesia was performed in 266 (22.1%) patients and not performed in 936 (77.9%). The incidence of postoperative pulmonary complications was greater in patients receiving adjuvant regional anesthesia (42.1%) than in patients without it (30.9%) (site adjusted p = 0.007), but this association was not confirmed after adjusting for covariates (adjusted OR 1.37; 95% CI, 0.83–2.25; p = 0.165).
Conclusion
After adjusting for surgical and patient complexity, adjuvant regional anesthesia versus general anesthesia alone was not associated with a greater incidence of postoperative pulmonary complications in this multicenter cohort of non-cardiothoracic surgery patients.

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Also Published In

Title
BMC Anesthesiology
DOI
https://doi.org/10.1186/s12871-022-01679-5

More About This Work

Published Here
July 22, 2024

Notes

Regional anesthesia, Adjuvant regional anesthesia, General anesthesia, Surgical outcomes, Postoperative pulmonary complications