Perioperative Supplemental Oxygen and Postoperative Copeptin Concentrations in Cardiac-Risk Patients Undergoing Major Abdominal Surgery—A Secondary Analysis of a Randomized Clinical Trial

Taschner, Alexander; Kabon, Barbara; Gráf, Alexandra; Adamowitsch, Nikolas; Sonnenburg, Markus Falkner von; Fraunschiel, Melanie; Horvath, Katharina; Fleischmann, Edith; Reiterer, Christian

doi:10.3390/jcm11082085

Cited by 3 publications

(1 citation statement)

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“…This manuscript adheres to the applicable CONSORT guidelines. The results of the primary outcome and several sub-analyses from the original trial have been published previously [3,[15][16][17].…”

Section: Methodsmentioning

confidence: 99%

Supplemental oxygen did not significantly affect two-year mortality in patients at-risk for cardiovascular complications undergoing moderate- to high-risk abdominal surgery–A follow-up analysis of a prospective randomized clinical trial

Taschner¹,

Fleischmann²,

Kabon³

et al. 2023

Front. Anesthesiol.

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BackgroundIn relatively healthy middle-aged patients, recent studies have shown that supplemental oxygen did not significantly increase one-year mortality after noncardiac surgery. If supplemental oxygen influences long-term mortality, specifically in elderly patients with cardiovascular risk-factors, remains unknown. Thus, we evaluated the effect of supplemental oxygen on two-year mortality in patients with cardiovascular risk factors undergoing moderate- to high-risk major abdominal surgery.MethodsThis is a follow-up study of a prospective, randomized, double-blinded, clinical trial. Two hundred fifty-eight patients, who were at least 45 years of age and at-risk for cardiovascular complications were randomly assigned to receive 80 vs. 30% oxygen during surgery and for the first two postoperative hours. Vital status was obtained from all patients 2 years after surgery using the national registry. Preoperative and postoperative maximum concentrations of NT-proBNP, Troponin T (TnT), Copeptin, von Willebrand Factor (vWF), static oxidation-reduction potential (sORP) and oxidation-reduction potential capacity (cORP) were tested for association with two-year mortality.ResultsThe median age of patients was 74 years (25th-75th percentile 70–78 years). 25.8% (95% CI: 17.3–32.4%) of patients in the 80% oxygen group and 22.3% (95% CI: 14.8–29.1%) in the 30% oxygen group died within 2 years after surgery. No significant difference in two-year mortality was found between patients, who received 80% oxygen concentration, versus patients, who received 30% oxygen concentration (estimated hazard ratio 1.145; 95% CI 0.693–1.893; p = 0.597). Preoperative Copeptin concentrations and postoperative maximum vWF activity were significantly associated with two-year mortality (p < 0.001).ConclusionOur results are consistent with previous studies, that showed that supplemental oxygen did not increase long-term mortality. Therefore, it is becoming more evident that supplemental oxygen may not have a significant effect on long-term outcome in patients undergoing major abdominal surgery.

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Section: Methodsmentioning

confidence: 99%

Supplemental oxygen did not significantly affect two-year mortality in patients at-risk for cardiovascular complications undergoing moderate- to high-risk abdominal surgery–A follow-up analysis of a prospective randomized clinical trial

Taschner¹,

Fleischmann²,

Kabon³

et al. 2023

Front. Anesthesiol.

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Hemodynamic effects of intraoperative 30% versus 80% oxygen concentrations: an exploratory analysis

et al. 2023

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BackgroundSupplemental oxygen leads to an increase in peripheral vascular resistance which finally increases systemic blood pressure in healthy subjects and patients with coronary artery disease, heart failure, undergoing heart surgery, and with sepsis. However, it is unknown whether this effect can also be observed in anesthetized patients having surgery. Thus, we evaluated in this exploratory analysis of a randomized controlled trial the effect of 80% versus 30% oxygen on intraoperative blood pressure and heart rate.MethodsWe present data from a previous study including 258 patients, who were randomized to a perioperative inspiratory FiO2 of 0.8 (128 patients) versus 0.3 (130 patients) for major abdominal surgery. Continuous arterial blood pressure values were recorded every three seconds and were exported from the electronic anesthesia record system. We calculated time-weighted average (TWA) and Average Real Variability (ARV) of mean arterial blood pressure and of heart rate.ResultsThere was no significant difference in TWA of mean arterial pressure between the 80% (80 mmHg [76, 85]) and 30% (81 mmHg [77, 86]) oxygen group (effect estimate −0.16 mmHg, CI –1.83 to 1.51; p = 0.85). There was also no significant difference in TWA of heart rate between the 80 and 30% oxygen group (median TWA of heart rate in the 80% oxygen group: 65 beats.min−1 [58, 72], and in the 30% oxygen group: 64 beats.min−1 [58; 70]; effect estimate: 0.12 beats.min−1, CI –2.55 to 2.8, p = 0.94). Also for ARV values, no significant differences between groups could be detected.ConclusionIn contrast to previous results, we did not observe a significant increase in blood pressure or a significant decrease in heart rate in patients, who received 80% oxygen as compared to patients, who received 30% oxygen during surgery and for the first two postoperative hours. Thus, hemodynamic effects of supplemental oxygen might play a negligible role in anesthetized patients.Clinical Trail Registrationhttps://clinicaltrials.gov/ct2/show/NCT03366857?term=vienna&cond=oxygen&draw=2&rank=1

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Effect of Supplemental Oxygen on von Willebrand Factor Activity and Ristocetin Cofactor Activity in Patients at Risk for Cardiovascular Complications Undergoing Moderate-to High-Risk Major Noncardiac Surgery—A Secondary Analysis of a Randomized Trial

Horvath

Taschner

Adamowitsch

et al. 2023

JCM

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Increased von Willebrand Factor (vWF) activity mediates platelet adhesion and might be a contributor to the development of thrombotic complications after surgery. Although in vitro studies have shown that hyperoxia induces endovascular damage, the effect of perioperative supplemental oxygen as a possible trigger for increased vWF activity has not been investigated yet. We tested our primary hypothesis that the perioperative administration of 80% oxygen concentration increases postoperative vWF activity as compared to 30% oxygen concentration in patients at risk of cardiovascular complications undergoing major noncardiac surgery. A total of 260 patients were randomly assigned to receive 80% versus 30% oxygen throughout surgery and for two hours postoperatively. We assessed vWF activity and Ristocetin cofactor activity in all patients shortly before the induction of anesthesia, within two hours after surgery and on the first and third postoperative day. Patient characteristics were similar in both groups. We found no significant difference in vWF activity in the overall perioperative time course between both randomization groups. We observed significantly increased vWF activity in the overall study population throughout the postoperative time course. Perioperative supplemental oxygen showed no significant effect on postoperative vWF and Ristocetin cofactor activity in cardiac risk patients undergoing major noncardiac surgery. In conclusion, we found no significant influence of supplemental oxygen in patients undergoing major non-cardiac surgery on postoperative vWF activity and Ristocetin cofactor activity.

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Perioperative Supplemental Oxygen and Postoperative Copeptin Concentrations in Cardiac-Risk Patients Undergoing Major Abdominal Surgery—A Secondary Analysis of a Randomized Clinical Trial

Cited by 3 publications

References 43 publications

Supplemental oxygen did not significantly affect two-year mortality in patients at-risk for cardiovascular complications undergoing moderate- to high-risk abdominal surgery–A follow-up analysis of a prospective randomized clinical trial

Supplemental oxygen did not significantly affect two-year mortality in patients at-risk for cardiovascular complications undergoing moderate- to high-risk abdominal surgery–A follow-up analysis of a prospective randomized clinical trial

Hemodynamic effects of intraoperative 30% versus 80% oxygen concentrations: an exploratory analysis

Effect of Supplemental Oxygen on von Willebrand Factor Activity and Ristocetin Cofactor Activity in Patients at Risk for Cardiovascular Complications Undergoing Moderate-to High-Risk Major Noncardiac Surgery—A Secondary Analysis of a Randomized Trial

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