Association of the intraoperative peripheral perfusion index with postoperative morbidity and mortality in acute surgical patients: a retrospective observational multicentre cohort study
We hypothesised that in acute high-risk surgical patients, a lower intraoperative peripheral perfusion index (PPI) would indicate a higher risk of postoperative complications and mortality. This retrospective observational study included 1338 acute high-risk surgical patients from November 2017 unti...
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| Veröffentlicht in: | British journal of anaesthesia : BJA 2021-09, Vol.127 (3), p.396-404 |
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| creator | Agerskov, Marianne Thusholdt, Anna N.W. Holm-Sørensen, Henrik Wiberg, Sebastian Meyhoff, Christian S. Højlund, Jakob Secher, Niels H. Foss, Nicolai B. |
| description | We hypothesised that in acute high-risk surgical patients, a lower intraoperative peripheral perfusion index (PPI) would indicate a higher risk of postoperative complications and mortality.
This retrospective observational study included 1338 acute high-risk surgical patients from November 2017 until October 2018 at two University Hospitals in Denmark. Intraoperative PPI was the primary exposure variable and the primary outcome was severe postoperative complications defined as a Clavien–Dindo Class ≥III or death, within 30 days.
intraoperative PPI was associated with severe postoperative complications or death: odds ratio (OR) 1.12 (95% confidence interval [CI] 1.05–1.19; P1.5 (P |
| doi_str_mv | 10.1016/j.bja.2021.06.004 |
| format | Article |
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This retrospective observational study included 1338 acute high-risk surgical patients from November 2017 until October 2018 at two University Hospitals in Denmark. Intraoperative PPI was the primary exposure variable and the primary outcome was severe postoperative complications defined as a Clavien–Dindo Class ≥III or death, within 30 days.
intraoperative PPI was associated with severe postoperative complications or death: odds ratio (OR) 1.12 (95% confidence interval [CI] 1.05–1.19; P<0.001), with an association of intraoperative mean PPI ≤0.5 and PPI ≤1.5 with the primary outcome: OR 1.79 (95% CI 1.09–2.91; P=0.02) and OR 1.65 (95% CI 1.20–2.27; P=0.002), respectively. Each 15-min increase in intraoperative time spend with low PPI was associated with the primary outcome (per 15 min with PPI ≤0.5: OR 1.11 (95% CI 1.05–1.17; P<0.001) and with PPI ≤1.5: OR 1.06 (95% CI 1.02–1.09; P=0.002)). Thirty-day mortality in patients with PPI ≤0.5 was 19% vs 10% for PPI >0.5, P=0.003. If PPI was ≤1.5, 30-day mortality was 16% vs 8% in patients with a PPI >1.5 (P<0.001). In contrast, intraoperative mean MAP ≤65 mm Hg was not significantly associated with severe postoperative complications or death (OR 1.21 [95% CI 0.92–1.58; P=0.2]).
Low intraoperative PPI was associated with severe postoperative complications or death in acute high-risk surgical patients. To guide intraoperative haemodynamic management, the PPI should be further investigated.</description><identifier>ISSN: 0007-0912</identifier><identifier>EISSN: 1471-6771</identifier><identifier>DOI: 10.1016/j.bja.2021.06.004</identifier><identifier>PMID: 34226038</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Aged ; Aged, 80 and over ; cardiac output ; Clinical Investigation ; clinical monitoring ; Denmark ; Female ; gold-directed therapy ; haemodynamics ; Hemodynamic Monitoring ; Humans ; Male ; Monitoring, Intraoperative ; Oximetry ; peripheral perfusion index ; Plethysmography ; postoperative complications ; Postoperative Complications - etiology ; Postoperative Complications - mortality ; Postoperative Complications - physiopathology ; Regional Blood Flow ; Retrospective Studies ; Risk Assessment ; Risk Factors ; surgery ; Surgical Procedures, Operative - adverse effects ; Surgical Procedures, Operative - mortality ; Time Factors ; Treatment Outcome</subject><ispartof>British journal of anaesthesia : BJA, 2021-09, Vol.127 (3), p.396-404</ispartof><rights>2021 The Authors</rights><rights>Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.</rights><rights>2021 The Authors 2021</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c451t-29220a385d957f906859ba69889c60fc28024a3745c9346d467b815d5bf1de833</citedby><cites>FETCH-LOGICAL-c451t-29220a385d957f906859ba69889c60fc28024a3745c9346d467b815d5bf1de833</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34226038$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Agerskov, Marianne</creatorcontrib><creatorcontrib>Thusholdt, Anna N.W.</creatorcontrib><creatorcontrib>Holm-Sørensen, Henrik</creatorcontrib><creatorcontrib>Wiberg, Sebastian</creatorcontrib><creatorcontrib>Meyhoff, Christian S.</creatorcontrib><creatorcontrib>Højlund, Jakob</creatorcontrib><creatorcontrib>Secher, Niels H.</creatorcontrib><creatorcontrib>Foss, Nicolai B.</creatorcontrib><title>Association of the intraoperative peripheral perfusion index with postoperative morbidity and mortality in acute surgical patients: a retrospective observational multicentre cohort study</title><title>British journal of anaesthesia : BJA</title><addtitle>Br J Anaesth</addtitle><description>We hypothesised that in acute high-risk surgical patients, a lower intraoperative peripheral perfusion index (PPI) would indicate a higher risk of postoperative complications and mortality.
This retrospective observational study included 1338 acute high-risk surgical patients from November 2017 until October 2018 at two University Hospitals in Denmark. Intraoperative PPI was the primary exposure variable and the primary outcome was severe postoperative complications defined as a Clavien–Dindo Class ≥III or death, within 30 days.
intraoperative PPI was associated with severe postoperative complications or death: odds ratio (OR) 1.12 (95% confidence interval [CI] 1.05–1.19; P<0.001), with an association of intraoperative mean PPI ≤0.5 and PPI ≤1.5 with the primary outcome: OR 1.79 (95% CI 1.09–2.91; P=0.02) and OR 1.65 (95% CI 1.20–2.27; P=0.002), respectively. Each 15-min increase in intraoperative time spend with low PPI was associated with the primary outcome (per 15 min with PPI ≤0.5: OR 1.11 (95% CI 1.05–1.17; P<0.001) and with PPI ≤1.5: OR 1.06 (95% CI 1.02–1.09; P=0.002)). Thirty-day mortality in patients with PPI ≤0.5 was 19% vs 10% for PPI >0.5, P=0.003. If PPI was ≤1.5, 30-day mortality was 16% vs 8% in patients with a PPI >1.5 (P<0.001). In contrast, intraoperative mean MAP ≤65 mm Hg was not significantly associated with severe postoperative complications or death (OR 1.21 [95% CI 0.92–1.58; P=0.2]).
Low intraoperative PPI was associated with severe postoperative complications or death in acute high-risk surgical patients. To guide intraoperative haemodynamic management, the PPI should be further investigated.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>cardiac output</subject><subject>Clinical Investigation</subject><subject>clinical monitoring</subject><subject>Denmark</subject><subject>Female</subject><subject>gold-directed therapy</subject><subject>haemodynamics</subject><subject>Hemodynamic Monitoring</subject><subject>Humans</subject><subject>Male</subject><subject>Monitoring, Intraoperative</subject><subject>Oximetry</subject><subject>peripheral perfusion index</subject><subject>Plethysmography</subject><subject>postoperative complications</subject><subject>Postoperative Complications - etiology</subject><subject>Postoperative Complications - mortality</subject><subject>Postoperative Complications - physiopathology</subject><subject>Regional Blood Flow</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>surgery</subject><subject>Surgical Procedures, Operative - adverse effects</subject><subject>Surgical Procedures, Operative - mortality</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>0007-0912</issn><issn>1471-6771</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kcuO1DAQRSMEYpqBD2CDvGSTYDuJHyAhjUa8pJHYwNpy7MrErSQOttPQv8bX4XQPA2xY2WWfulW6tyieE1wRTNirfdXtdUUxJRVmFcbNg2JHGk5Kxjl5WOwwxrzEktCL4kmMe4wJp7J9XFzUDaUM12JX_LyK0Runk_Mz8j1KAyA3p6D9AiG_HgDli1uGXI3btV_jhrrZwg_03aUBLT6mP_TkQ-esS0ekZ7tVSY9b5WakzZoAxTXcOrOJ5QaYU3yNNAqQgo8LmJOG7yKEw2mnzE3rmJzJZABk_JAVUUyrPT4tHvV6jPDs7rwsvr5_9-X6Y3nz-cOn66ub0jQtSSWVlGJdi9bKlvcSM9HKTjMphDQM94YKTBtd86Y1sm6YbRjvBGlt2_XEgqjry-LtWXdZuwnsaRM9qiW4SYej8tqpf39mN6hbf1Aiz6c1ywIv7wSC_7ZCTGpy0cA46hn8GhVtG5FDkpxnlJxRk-2IAfr7MQSrLXO1VzlztWWuMFM589zz4u_97jt-h5yBN2cAsksHB0FFk503YF3Ijivr3X_kfwEqesPu</recordid><startdate>20210901</startdate><enddate>20210901</enddate><creator>Agerskov, Marianne</creator><creator>Thusholdt, Anna N.W.</creator><creator>Holm-Sørensen, Henrik</creator><creator>Wiberg, Sebastian</creator><creator>Meyhoff, Christian S.</creator><creator>Højlund, Jakob</creator><creator>Secher, Niels H.</creator><creator>Foss, Nicolai B.</creator><general>Elsevier Ltd</general><general>Elsevier</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20210901</creationdate><title>Association of the intraoperative peripheral perfusion index with postoperative morbidity and mortality in acute surgical patients: a retrospective observational multicentre cohort study</title><author>Agerskov, Marianne ; Thusholdt, Anna N.W. ; Holm-Sørensen, Henrik ; Wiberg, Sebastian ; Meyhoff, Christian S. ; Højlund, Jakob ; Secher, Niels H. ; Foss, Nicolai B.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c451t-29220a385d957f906859ba69889c60fc28024a3745c9346d467b815d5bf1de833</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>cardiac output</topic><topic>Clinical Investigation</topic><topic>clinical monitoring</topic><topic>Denmark</topic><topic>Female</topic><topic>gold-directed therapy</topic><topic>haemodynamics</topic><topic>Hemodynamic Monitoring</topic><topic>Humans</topic><topic>Male</topic><topic>Monitoring, Intraoperative</topic><topic>Oximetry</topic><topic>peripheral perfusion index</topic><topic>Plethysmography</topic><topic>postoperative complications</topic><topic>Postoperative Complications - etiology</topic><topic>Postoperative Complications - mortality</topic><topic>Postoperative Complications - physiopathology</topic><topic>Regional Blood Flow</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>surgery</topic><topic>Surgical Procedures, Operative - adverse effects</topic><topic>Surgical Procedures, Operative - mortality</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Agerskov, Marianne</creatorcontrib><creatorcontrib>Thusholdt, Anna N.W.</creatorcontrib><creatorcontrib>Holm-Sørensen, Henrik</creatorcontrib><creatorcontrib>Wiberg, Sebastian</creatorcontrib><creatorcontrib>Meyhoff, Christian S.</creatorcontrib><creatorcontrib>Højlund, Jakob</creatorcontrib><creatorcontrib>Secher, Niels H.</creatorcontrib><creatorcontrib>Foss, Nicolai B.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>British journal of anaesthesia : BJA</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Agerskov, Marianne</au><au>Thusholdt, Anna N.W.</au><au>Holm-Sørensen, Henrik</au><au>Wiberg, Sebastian</au><au>Meyhoff, Christian S.</au><au>Højlund, Jakob</au><au>Secher, Niels H.</au><au>Foss, Nicolai B.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Association of the intraoperative peripheral perfusion index with postoperative morbidity and mortality in acute surgical patients: a retrospective observational multicentre cohort study</atitle><jtitle>British journal of anaesthesia : BJA</jtitle><addtitle>Br J Anaesth</addtitle><date>2021-09-01</date><risdate>2021</risdate><volume>127</volume><issue>3</issue><spage>396</spage><epage>404</epage><pages>396-404</pages><issn>0007-0912</issn><eissn>1471-6771</eissn><abstract>We hypothesised that in acute high-risk surgical patients, a lower intraoperative peripheral perfusion index (PPI) would indicate a higher risk of postoperative complications and mortality.
This retrospective observational study included 1338 acute high-risk surgical patients from November 2017 until October 2018 at two University Hospitals in Denmark. Intraoperative PPI was the primary exposure variable and the primary outcome was severe postoperative complications defined as a Clavien–Dindo Class ≥III or death, within 30 days.
intraoperative PPI was associated with severe postoperative complications or death: odds ratio (OR) 1.12 (95% confidence interval [CI] 1.05–1.19; P<0.001), with an association of intraoperative mean PPI ≤0.5 and PPI ≤1.5 with the primary outcome: OR 1.79 (95% CI 1.09–2.91; P=0.02) and OR 1.65 (95% CI 1.20–2.27; P=0.002), respectively. Each 15-min increase in intraoperative time spend with low PPI was associated with the primary outcome (per 15 min with PPI ≤0.5: OR 1.11 (95% CI 1.05–1.17; P<0.001) and with PPI ≤1.5: OR 1.06 (95% CI 1.02–1.09; P=0.002)). Thirty-day mortality in patients with PPI ≤0.5 was 19% vs 10% for PPI >0.5, P=0.003. If PPI was ≤1.5, 30-day mortality was 16% vs 8% in patients with a PPI >1.5 (P<0.001). In contrast, intraoperative mean MAP ≤65 mm Hg was not significantly associated with severe postoperative complications or death (OR 1.21 [95% CI 0.92–1.58; P=0.2]).
Low intraoperative PPI was associated with severe postoperative complications or death in acute high-risk surgical patients. To guide intraoperative haemodynamic management, the PPI should be further investigated.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>34226038</pmid><doi>10.1016/j.bja.2021.06.004</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Aged, 80 and over cardiac output Clinical Investigation clinical monitoring Denmark Female gold-directed therapy haemodynamics Hemodynamic Monitoring Humans Male Monitoring, Intraoperative Oximetry peripheral perfusion index Plethysmography postoperative complications Postoperative Complications - etiology Postoperative Complications - mortality Postoperative Complications - physiopathology Regional Blood Flow Retrospective Studies Risk Assessment Risk Factors surgery Surgical Procedures, Operative - adverse effects Surgical Procedures, Operative - mortality Time Factors Treatment Outcome |
| title | Association of the intraoperative peripheral perfusion index with postoperative morbidity and mortality in acute surgical patients: a retrospective observational multicentre cohort study |
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