Respiratory complications after oesophagectomy using volatile or intravenous anaesthesia

BACKGROUND: The anaesthesia regimen may affect the risk of postoperative respiratory complications. However, the optimal anaesthetic choice for oesophagectomy remains unclear. This retrospective study compared the effect of desflurane, sevoflurane, and propofol anaesthesia on short-term outcomes after oesophagectomy. METHODS: Data of patients who underwent oesophagectomy for cancer during April 2012-March 2022 were extracted from a nationwide Japanese inpatient database. Propensity score matching weight analysis was conducted to compare respiratory complications, ventilatory failure, and in-hospital mortality between desflurane, sevoflurane, and propofol anaesthesia, adjusting for potential confounders. Sensitivity analyses were performed using multivariable logistic regression and instrumental variable analyses. RESULTS: Among 21 080 included patients (desflurane group 7823, sevoflurane group 8932, and propofol group 4325 patients), respiratory complications and ventilatory failure occurred in 3399 (16.1%) and 960 (4.6%) patients respectively. Upon matching weight analysis, sevoflurane and propofol anaesthesia were significantly associated with higher incidences of respiratory complications (OR 1.13, 95% c.i. 1.03 to 1.24 and OR 1.43, 95% c.i. 1.28 to 1.58 respectively) and ventilatory failure (OR 1.21, 95% c.i. 1.02 to 1.43 and OR 1.29, 95% c.i. 1.06 to 1.56 respectively) compared with desflurane anaesthesia. In-hospital mortality after desflurane anaesthesia was the lowest of the three anaesthesia (1.6% and 1.8% versus 1.2%; OR 1.30, 95% c.i. 0.98 to 1.73 and OR 1.49, 95% c.i. 1.08 to 2.06 respectively). Multivariable logistic regression and instrumental variable analyses demonstrated similar results. CONCLUSIONS: Sevoflurane and propofol anaesthesia for oesophagectomy were associated with worse respiratory outcomes compared with desflurane anaesthesia.