Perioperative medicine & outcomes
Determinants and Practice Variability of Oxygen Administration during Surgery in the United States: A Retrospective Cohort Study
Authors' conclusion
Among adults undergoing surgery with anesthesia and tracheal intubation, supplemental oxygen administration was variable and appeared arbitrary. Most patient and procedure factors had statistical but minor clinical associations with oxygen administration. Medical center and anesthesia provider explained significantly more variability in oxygen administration than patient or procedure factors.
Study context
- Population
- Adults undergoing surgery ≥120 min under GA with tracheal intubation, admitted after surgery, 42 US medical centers (Multicenter Perioperative Outcomes Group), January 2016–January 2019
- Participants
- 367,841 cases
- Outcome
- Determinants and variability of intraoperative FiO2
Methodological detailsmulticentre registry, multivariable linear mixed-effects regression
- Multicentre registry
- Multivariable linear mixed-effects regression
Main finding
As reported in the abstract
Intraoperative FiO2 and sources of its variability
- Median (25th, 75th) FiO2
- 0.55 (0.48, 0.61)
- Cases with FiO2 <0.40
- 6.9%
- Cases with FiO2 >0.90
- 8.7%
- Variability explained by patient factors
- 3.5% (95% CI 3.5 to 3.5%)
- Variability explained by procedure factors
- 4.4% (95% CI 4.2 to 4.6%)
- Variability explained by anesthesiologist
- 7.7% (95% CI 7.2 to 8.2%)
- Variability explained by in-room anesthesia provider
- 8.1% (95% CI 7.8 to 8.4%)
- Variability explained by medical center
- 23.3% (95% CI 22.4 to 24.2%)
- Unexplained variability
- 53.0% (95% CI 52.4 to 53.6%)
Observational data: associations, not effects.
Further findings
Patient and procedure factors associated with FiO2
- Advanced ASA class, heart disease, emergency surgery and cardiac surgery associated with increased FiO2; most factors of little clinical significance (<1% inspired oxygen change)
Original publication
Determinants and Practice Variability of Oxygen Administration during Surgery in the United States: A Retrospective Cohort Study. Anesthesiology. Published 17 May 2024. doi:10.
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