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Association between perioperative hyperoxia and cerebrovascular complications after laparotomy—A post‐hoc follow‐up study
Author(s) -
Kongebro Emilie Katrine,
Jorgensen Lars N.,
Siersma Volkert D.,
Meyhoff Christian Sahlholt
Publication year - 2019
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.13235
Subject(s) - medicine , perioperative , hyperoxia , stroke (engine) , hazard ratio , anesthesia , proportional hazards model , abdominal surgery , confidence interval , lung , mechanical engineering , engineering
Background Perioperative hyperoxia has been linked to increased long‐term mortality. Vasoconstrictive and cellular side effects to hyperoxia have been suggested to increase the risk of coronary and cerebral ischemia. The aim of this post‐hoc analysis of a large randomized trial was to compare the effects of 80% vs 30% perioperative oxygen on the long‐term risk of stroke or transient cerebral ischemia ( TCI ) in patients undergoing abdominal surgery. Methods A total of 1386 patients were randomized to 80% or 30% perioperative oxygen during acute or elective open abdominal surgery. Median follow‐up was 3.9 years. Primary outcome was a composite of the long‐term occurrence of stroke or TCI . Secondary outcomes included long‐term mortality without stroke or TCI , and incidences of neurological admission, psychiatric admission, and dementia. Outcomes were analyzed in Cox regression models. Results Stroke or TCI occurred in 20 (3.0%) patients given 80% oxygen vs 22 (3.2%) patients given 30% oxygen with an adjusted hazard ratio ( HR ) of 0.96 [95% CI 0.52‐1.76]. Composite secondary outcome of death, stroke, or TCI had a HR of 1.21 [95% CI 1.00‐1.47] for 80% compared to 30% oxygen. HR s for secondary outcomes were HR 1.14 [95% CI 0.79‐1.64] for neurological admission, 1.34 [95% CI 0.95‐1.88] for psychiatric admission and 0.54 [95% CI 0.16‐1.80] for dementia. Conclusion Stroke or TCI did not seem related to perioperative inspiratory oxygen fraction. Due to few events, this study cannot exclude that perioperative hyperoxia increases risk of mortality, stroke, or TCI after abdominal surgery.