Lu Che, Jia-Wen Yu, Yue-Lun Zhang, Li Xu, Yu-Guang Huang
{"title":"术中血压不稳定是目标导向液体疗法对脊柱大手术患者术后并发症影响的关键中介。","authors":"Lu Che, Jia-Wen Yu, Yue-Lun Zhang, Li Xu, Yu-Guang Huang","doi":"10.24920/004202","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>Although goal-directed fluid therapy (GDFT) has been proven to be effective in reducing the incidence of postoperative complications, the underlying mechanisms remain unknown. The aim of this study was to examine the mediating role of intraoperative hemodynamic lability in the association between GDFT and the incidence of postoperative complications. We further tested the role of this mediation effect using mean arterial pressure, a hemodynamic indicator.</div></div><div><h3>Methods</h3><div>This secondary analysis used the dataset of a completed nonrandomized controlled study to investigate the effect of GDFT on the incidence of postoperative complications in patients undergoing posterior spine arthrodesis. We used a simple mediation model to test whether there was a mediation effect of average real variability between the association of GDFT and postoperative complications. We conducted mediation analysis using the mediation package in R (version 3.1.2), based on 5,000 bootstrapped samples, adjusting for covariates.</div></div><div><h3>Results</h3><div>Among the 300 patients in the study, 40% (120/300) developed postoperative complications within 30 days. GDFT was associated with fewer 30-day postoperative complications after adjustment for confounders (odds ratio: 0.460, 95% <em>CI:</em> 0.278, 0.761; <em>P</em> = 0.003). The total effect of GDFT on postoperative complications was –0.18 (95% <em>CI</em>: –0.28, –0.07; <em>P</em> < 0.01). The average causal mediation effect was –0.08 (95% <em>CI</em>: –0.15, –0.04; <em>P</em> < 0.01). The average direct effect was –0.09 (95% <em>CI</em>: –0.20, 0.03; <em>P</em> = 0.17). The proportion mediated was 49.9% (95% <em>CI</em>: 18.3%, 140.0%).</div></div><div><h3>Conclusions</h3><div>The intraoperative blood pressure lability mediates the relationship between GDFT and the incidence of postoperative complications. Future research is needed to clarify whether actively reducing intraoperative blood pressure lability can prevent postoperative complications.</div></div>","PeriodicalId":35615,"journal":{"name":"Chinese Medical Sciences Journal","volume":"38 4","pages":"Pages 257-264"},"PeriodicalIF":0.0000,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Intraoperative Blood Pressure Lability Acts as a Key Mediator in the Impacts of Goal-Directed Fluid Therapy on Postoperative Complications in Patients Undergoing Major Spine Surgery\",\"authors\":\"Lu Che, Jia-Wen Yu, Yue-Lun Zhang, Li Xu, Yu-Guang Huang\",\"doi\":\"10.24920/004202\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><div>Although goal-directed fluid therapy (GDFT) has been proven to be effective in reducing the incidence of postoperative complications, the underlying mechanisms remain unknown. The aim of this study was to examine the mediating role of intraoperative hemodynamic lability in the association between GDFT and the incidence of postoperative complications. We further tested the role of this mediation effect using mean arterial pressure, a hemodynamic indicator.</div></div><div><h3>Methods</h3><div>This secondary analysis used the dataset of a completed nonrandomized controlled study to investigate the effect of GDFT on the incidence of postoperative complications in patients undergoing posterior spine arthrodesis. We used a simple mediation model to test whether there was a mediation effect of average real variability between the association of GDFT and postoperative complications. We conducted mediation analysis using the mediation package in R (version 3.1.2), based on 5,000 bootstrapped samples, adjusting for covariates.</div></div><div><h3>Results</h3><div>Among the 300 patients in the study, 40% (120/300) developed postoperative complications within 30 days. GDFT was associated with fewer 30-day postoperative complications after adjustment for confounders (odds ratio: 0.460, 95% <em>CI:</em> 0.278, 0.761; <em>P</em> = 0.003). The total effect of GDFT on postoperative complications was –0.18 (95% <em>CI</em>: –0.28, –0.07; <em>P</em> < 0.01). The average causal mediation effect was –0.08 (95% <em>CI</em>: –0.15, –0.04; <em>P</em> < 0.01). The average direct effect was –0.09 (95% <em>CI</em>: –0.20, 0.03; <em>P</em> = 0.17). The proportion mediated was 49.9% (95% <em>CI</em>: 18.3%, 140.0%).</div></div><div><h3>Conclusions</h3><div>The intraoperative blood pressure lability mediates the relationship between GDFT and the incidence of postoperative complications. Future research is needed to clarify whether actively reducing intraoperative blood pressure lability can prevent postoperative complications.</div></div>\",\"PeriodicalId\":35615,\"journal\":{\"name\":\"Chinese Medical Sciences Journal\",\"volume\":\"38 4\",\"pages\":\"Pages 257-264\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2023-12-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Chinese Medical Sciences Journal\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1001929424000026\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Chinese Medical Sciences Journal","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1001929424000026","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"Medicine","Score":null,"Total":0}
Intraoperative Blood Pressure Lability Acts as a Key Mediator in the Impacts of Goal-Directed Fluid Therapy on Postoperative Complications in Patients Undergoing Major Spine Surgery
Objective
Although goal-directed fluid therapy (GDFT) has been proven to be effective in reducing the incidence of postoperative complications, the underlying mechanisms remain unknown. The aim of this study was to examine the mediating role of intraoperative hemodynamic lability in the association between GDFT and the incidence of postoperative complications. We further tested the role of this mediation effect using mean arterial pressure, a hemodynamic indicator.
Methods
This secondary analysis used the dataset of a completed nonrandomized controlled study to investigate the effect of GDFT on the incidence of postoperative complications in patients undergoing posterior spine arthrodesis. We used a simple mediation model to test whether there was a mediation effect of average real variability between the association of GDFT and postoperative complications. We conducted mediation analysis using the mediation package in R (version 3.1.2), based on 5,000 bootstrapped samples, adjusting for covariates.
Results
Among the 300 patients in the study, 40% (120/300) developed postoperative complications within 30 days. GDFT was associated with fewer 30-day postoperative complications after adjustment for confounders (odds ratio: 0.460, 95% CI: 0.278, 0.761; P = 0.003). The total effect of GDFT on postoperative complications was –0.18 (95% CI: –0.28, –0.07; P < 0.01). The average causal mediation effect was –0.08 (95% CI: –0.15, –0.04; P < 0.01). The average direct effect was –0.09 (95% CI: –0.20, 0.03; P = 0.17). The proportion mediated was 49.9% (95% CI: 18.3%, 140.0%).
Conclusions
The intraoperative blood pressure lability mediates the relationship between GDFT and the incidence of postoperative complications. Future research is needed to clarify whether actively reducing intraoperative blood pressure lability can prevent postoperative complications.
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