Philippe Dony1, Michele Dramaix2, Jean G Boogaerts3. 1. Department of Anesthesiology, University Hospital Center of Charleroi, Belgium. 2. School of Public Health, Research Center for Epidemiology, Free University of Brussels, 1070 Brussels, Belgium. 3. Department of Anesthesiology, University Hospital Center of Charleroi, Belgium. Electronic address: jean.boogaerts@chu-charleroi.be.
Abstract
STUDY OBJECTIVE: To evaluate the relationship between intraoperative end-tidal carbon dioxide (etco2) values and clinical outcomes with special attention on 30-day postoperative mortality and secondarily on hospital length of stay (LOS). DESIGN: Retrospective, observational study. SETTING: Surgical theaters of the University Hospital Center of Charleroi. PATIENTS: Five thousand three hundred seventeen patients ASA I-IV undergoing various surgical procedures (except pediatric and cardiac surgery) under general anesthesia. INTERVENTIONS: No intervention on the patients. MEASUREMENTS: The mean etco2 level measured during anesthesia was secondarily extracted from an electronic information management system. Patients were divided into 2 separate groups based on etco2 values less than or greater than or equal to 35 mm Hg. The primary end point was the in- and outhospital mortality in the 30-day period after surgery. The second was the LOS more than 6 days. MAIN RESULTS: Hypocapnia occurred in 66% of the patients. Mortality rate at 30-day was 84 of 3554 (2.4%) in the low etco2 group vs 15 of 1763 (0.9%) in the other (odds ratio, 2.99 [1.69-5.28]; P<.001). In multivariate analysis, age and ASA scores had significant independent associations with mortality rate. Adjusting for these factors had an effect on the relative odds ratio of etco2 on mortality of 1.99 ([1.11-3.56]; P<.001). Patients with low etco2 experienced higher LOS (14.1±9.4 vs 13.1±8.9 days; P<.001). Thirty five percent of the patients in the low etco2 group were still hospitalized more than 6 days compared with 30% in the other (P<.001). CONCLUSION: Low etco2 level during anesthesia is associated with an increase in postoperative mortality rate and LOS. These results emphasize the importance of preventing hypocapnia during anesthesia to improve surgical outcomes.
STUDY OBJECTIVE: To evaluate the relationship between intraoperative end-tidal carbon dioxide (etco2) values and clinical outcomes with special attention on 30-day postoperative mortality and secondarily on hospital length of stay (LOS). DESIGN: Retrospective, observational study. SETTING: Surgical theaters of the University Hospital Center of Charleroi. PATIENTS: Five thousand three hundred seventeen patientsASA I-IV undergoing various surgical procedures (except pediatric and cardiac surgery) under general anesthesia. INTERVENTIONS: No intervention on the patients. MEASUREMENTS: The mean etco2 level measured during anesthesia was secondarily extracted from an electronic information management system. Patients were divided into 2 separate groups based on etco2 values less than or greater than or equal to 35 mm Hg. The primary end point was the in- and outhospital mortality in the 30-day period after surgery. The second was the LOS more than 6 days. MAIN RESULTS:Hypocapnia occurred in 66% of the patients. Mortality rate at 30-day was 84 of 3554 (2.4%) in the low etco2 group vs 15 of 1763 (0.9%) in the other (odds ratio, 2.99 [1.69-5.28]; P<.001). In multivariate analysis, age and ASA scores had significant independent associations with mortality rate. Adjusting for these factors had an effect on the relative odds ratio of etco2 on mortality of 1.99 ([1.11-3.56]; P<.001). Patients with low etco2 experienced higher LOS (14.1±9.4 vs 13.1±8.9 days; P<.001). Thirty five percent of the patients in the low etco2 group were still hospitalized more than 6 days compared with 30% in the other (P<.001). CONCLUSION: Low etco2 level during anesthesia is associated with an increase in postoperative mortality rate and LOS. These results emphasize the importance of preventing hypocapnia during anesthesia to improve surgical outcomes.
Authors: Annemarie Akkermans; Judith A R van Waes; Aleda Thompson; Amy Shanks; Linda M Peelen; Michael F Aziz; Daniel A Biggs; William C Paganelli; Jonathan P Wanderer; Daniel L Helsten; Sachin Kheterpal; Wilton A van Klei; Leif Saager Journal: Can J Anaesth Date: 2018-11-14 Impact factor: 5.063
Authors: Aliyah Snyder; Christopher Sheridan; Alexandra Tanner; Kevin Bickart; Molly Sullan; Michelle Craske; Meeryo Choe; Talin Babikian; Christopher Giza; Robert Asarnow Journal: J Clin Med Date: 2021-02-03 Impact factor: 4.241