Key result
A mean intra-operative nociceptive response index ≥0.83 was associated with a higher incidence of major postoperative complications compared to an index <0.83.
Why the study?
An intra-operative quantitative index of surgical invasiveness could assist anaesthetic management in predicting and preventing major postoperative complications, but no such index is available.
Does a high intra-operative nociceptive response index predict postoperative major complications in adult patients undergoing gastrointestinal surgery under general anaesthesia?
Observational (n=789)
Yes
Does a high intra-operative nociceptive response index predict postoperative major complications in adult patients undergoing gastrointestinal surgery under general anaesthesia?
A higher mean nociceptive response index during gastrointestinal surgery is independently associated with an increased risk of major postoperative complications.
Answers are grounded in this paper and cite their sources.
May support intraoperative nociceptive monitoring for risk stratification; hypothesis-generating for trials targeting lower indices.
BACKGROUND: Surgical procedures stimulate nociception and induce physiological responses according to the balance between nociception and antinociception. The severity of surgical stimuli is associated with major postoperative complications. Although an intra-operative quantitative index representing surgical invasiveness would be useful for anaesthetic management to predict and prevent major complications, no such index is available. OBJECTIVES: To identify associations between major complications after gastrointestinal surgery and intra-operative quantitative values from intra-operative nociception monitoring. DESIGN: A multi-institutional observational study. SETTING: Two university hospitals. PATIENTS: Consecutive adult patients undergoing gastrointestinal surgery under general anaesthesia. MAIN OUTCOME MEASURES: Averaged values of nociceptive response index from start to end of surgery (mean NR index) and risk scores of the Surgical Mortality Probability Model (S-MPM) were calculated. Pre and postoperative serum C-reactive protein (CRP) levels were obtained. After receiver-operating characteristic (ROC) curve analysis, all patients were divided into groups with high and low mean nociceptive response index. Associations between mean nociceptive response index and postoperative major complications, defined as Clavien-Dindo grade at least IIIa, were examined using logistic regression analysis. RESULTS: ROC curve analysis showed a nociceptive response index cut-off value for major complications of 0.83, and we divided patients into two groups with mean nociceptive response index less than 0.83 and at least 0.83. The incidence of major complications was significantly higher in patients with mean nociceptive response index at least 0.83 (23.1%; n = 346) than in patients with mean nociceptive response index less than 0.83 (7.7%; n = 443; P < 0.001). Multivariate analysis revealed emergency surgery, S-MPM risk score, mean nociceptive response index and postoperative CRP levels as independent risk factors for major complications. CONCLUSION: Mean nociceptive response index during surgery likely correlates with major complications after gastrointestinal surgery. TRIAL REGISTRATION: The current observational study had no intervention, and was therefore, not registered.
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A 2021 study conducted an observational in Gastrointestinal surgery (n=789). Mean nociceptive response index ≥0.83 vs. Mean nociceptive response index <0.83 was evaluated on Postoperative major complications (Clavien-Dindo grade ≥IIIa) (p=<0.001). A mean intra-operative nociceptive response index ≥0.83 was associated with a higher incidence of major postoperative complications compared to an index <0.83.
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