Key result
Arterial pulse waveform analysis shows no link to in-hospital mortality in high-risk non-cardiac surgeries.
Why the study?
No study had assessed whether real-world use of a specialized pressure transducer for arterial pulse waveform analysis (S-APWA) is associated with post-operative outcomes.
Does the use of a specialized pressure transducer for arterial pulse waveform analysis (S-APWA) reduce in-hospital mortality in adult patients undergoing high-risk non-cardiac surgery?
Cohort (n=23,655)
Yes
Does the use of a specialized pressure transducer for arterial pulse waveform analysis (S-APWA) reduce in-hospital mortality in adult patients undergoing high-risk non-cardiac surgery?
Effect estimate: aOR 0.91 (95% CI 0.76-1.07)
p-value: p=.25
The real-world use of S-APWA for perioperative goal-directed fluid therapy in high-risk non-cardiac surgeries is not associated with an overall reduction in in-hospital mortality, though outcomes may vary by surgery type.
BACKGROUND: Perioperative goal-directed fluid therapy is used for haemodynamic optimization in high-risk surgeries. Cardiac output monitoring can be performed by a specialized pressure transducer for arterial pulse waveform analysis (S-APWA). No study has assessed whether real-world use of S-APWA is associated with post-operative outcomes; therefore, using a Japanese administrative claims database, we retrospectively investigated whether S-APWA use is associated with in-hospital mortality among patients undergoing high-risk surgery under general anaesthesia. METHODS: Adult patients who underwent high-risk surgery under general anaesthesia and arterial catheterization between 2014 and 2016 were divided into S-APWA and conventional arterial pressure transducer groups, then compared regarding baseline factors and outcomes. Logistic regression analysis was performed to compare in-hospital mortality. Subgroup analyses evaluated S-APWA efficacy and outcomes based on the type of surgery and patients' comorbidity. RESULTS: S-APWA was used in 6859 of 23 655 (29.0%) patients; the crude in-hospital mortality rate was 3.5%. Adjusted analysis showed no significant association between S-APWA use and in-hospital mortality rate (adjusted odds ratio [aOR] = 0.91; 95% confidence interval [CI]: 0.76-1.07; P = .25). S-APWA use was associated with significantly lower in-hospital mortality in patients undergoing vascular surgery (aOR = 0.67; 95% CI: 0.49-0.94), and significantly higher in-hospital mortality in patients undergoing lower limb amputation (aOR = 2.63; 95% CI: 1.32-5.22). S-APWA use and in-hospital mortality were not significantly associated with other subgroups. CONCLUSION: S-APWA use was not associated with in-hospital mortality in the entire study population. However, S-APWA was associated with decreased in-hospital mortality among vascular surgery and increased in-hospital mortality among lower limb amputation.
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Takeda et al. (2020) conducted a cohort in High-risk non-cardiac surgeries (n=23,655). Specialized pressure transducer for arterial pulse waveform analysis (S-APWA) vs. Conventional arterial pressure transducer was evaluated on In-hospital mortality (aOR 0.91, 95% CI 0.76-1.07, p=.25). Arterial pulse waveform analysis was not significantly associated with in-hospital mortality in high-risk non-cardiac surgeries (aOR 0.91; 95% CI 0.76-1.07; P=0.25).
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