Respiratory failure & ventilation
The association of intraoperative low driving pressure ventilation and nonhome discharge: a historical cohort study
Main finding · Nonhome dischargeResult — go to the resultAdjusted odds ratio 0.88 95% CI 0.83–0.93Authors' conclusion
Intraoperative ventilation maintaining lower driving pressure was associated with a lower risk of nonhome discharge, which can be partially explained by lowered rates of postoperative respiratory failure.
Study context
- Population
- Patients aged ≥ 60 yr living at home before elective noncardiothoracic surgery, two tertiary healthcare networks in Massachusetts, 2007–2018
- Participants
- 87,407 patients
- Exposure
- Lower vs higher median intraoperative driving pressure
- Outcome
- Nonhome discharge
Methodological detailsmultivariable logistic regression, two tertiary healthcare networks
- Multivariable logistic regression
- Two tertiary healthcare networks
Main finding
As reported in the abstract
Adjusted odds ratio
0.88
95% CI 0.83–0.93
P < 0.001
Low driving pressure vs High driving pressure
aOR 0.88 (95% CI 0.83–0.93); P < 0.001
- Patients with nonhome discharge (overall)
- 12,584 (14.4%)
Observational data: associations, not effects.
Further findings
| Outcome | aOR (95% CI) | P value | |
|---|---|---|---|
| Nonhome discharge, high baseline risk (subgroup)Per 10 cm H2O decrease | 0.77 (0.73–0.81) | ||
| Nonhome discharge, compliance-matched cohortLow [< 15 cm H2O] vs high [≥ 15 cm H2O] · matched cohort | 0.90 (0.81–1.00) | P = 0.04 | |
| 0.512Adjusted odds ratio (log scale) |
- Nonhome discharge, high baseline risk (subgroup): P-for-interaction < 0.001
- Nonhome discharge, compliance-matched cohort: 19,518 patients matched for baseline respiratory system compliance
Mediation by postoperative respiratory failure
- Proportion of association mediated by lower risk of respiratory failure
- 20.8%; 95% CI, 15.0 to 56.8; P < 0.001
Original publication
The association of intraoperative low driving pressure ventilation and nonhome discharge: a historical cohort study. Can J Anaesth. Published 25 January 2023. doi:10.
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