Perioperative medicine & outcomes
Mechanical Power and the Association with Postoperative Impaired Oxygenation and Pulmonary Complications in Orthopedic Patients: Post Hoc Analysis of a Cluster Factorial Randomized Trial
Primary result · SF-TWA in PACU per 0.1 J/min/kg increment in mechanical powerResult — go to the resultReduction −11 95% CI −14 to −8Authors' conclusion
Higher intraoperative mechanical power was associated with impaired postoperative oxygenation and pulmonary complications in patients undergoing orthopedic surgery.
Study context
- Population
- Patients having orthopedic surgery ventilated with tidal volumes of 6 vs 10 ml/kg predicted bodyweight and PEEP of 5 vs 8 cm H 2 O
- Participants
- 2,582 patients · 2,860 surgeries
- Comparison
- Intraoperative mechanical power normalized to predicted bodyweight
- Primary endpoint
- Time-weighted average SpO2/FiO2 ratio (SF-TWA) in PACU
- Follow-up
- First hour of PACU stay
Methodological detailsmultivariable linear mixed model
- Multivariable linear mixed model
Primary result
As reported in the abstract
SF-TWA in PACU per 0.1 J/min/kg increment in mechanical power
Reduction
−11
95% CI −14 to −8
P < 0.001
0.1 J/min/kg increment in mechanical power
reduction −11 (95% CI −14 to −8); P < 0.001
Per 0.1 J/min/kg increment in mechanical power, as printed
- Mean ± SD mechanical power normalized to predicted bodyweight (J/min/kg)
- 0.20 ± 0.06
- Mean ± SD SF-TWA in postanesthesia care unit (PACU)
- 353 ± 41
Further findings
| Outcome | Reduction (95% CI) | P value | |
|---|---|---|---|
| SF-TWA in wards per 0.1 J/min/kg increment | −8 (−11 to −5) | P < 0.001 | |
| −15−10−505Difference (linear scale) |
| Outcome | OR (95% CI) | P value | |
|---|---|---|---|
| PPCs per 0.1 J/min/kg increment55% higher odds | 1.55 (1.05–2.27) | P = 0.026 | |
| 0.512Odds ratio (log scale) |
Postoperative hospital LOS
| OR (95% CI) | P value | ||
|---|---|---|---|
| Mechanical power normalized to predicted bodyweightUnrelated | 1.01 (0.97–1.05) | P = 0.68 | |
| 0.512Odds ratio (log scale) |
Variance in postoperative oxygenation explained (marginal R2)
- Models with peak or driving pressures
- 0.207
- Model with mechanical power normalized to predicted bodyweight
- 0.210
Original publication
Mechanical Power and the Association with Postoperative Impaired Oxygenation and Pulmonary Complications in Orthopedic Patients: Post Hoc Analysis of a Cluster Factorial Randomized Trial. Anesthesiology. Published 18 December 2025. doi:10.
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