Karam Azem, Philip Heesen, Eitan Mangoubi, Sharon Orbach-Zinger, Roussana Aranbitski, Shai Fein, Benjamin Zribi
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Volatile anaesthetic exposure was quantified as age-adjusted minimum alveolar concentration-hours (MAC<sub>hr</sub>). We examined associations with reoperation (within 30 days) and AKI (within 7 days) and compared agent-specific effects using mixed-effects logistic regression.</p><p><strong>Results: </strong>A total of 16,685 patients were included in the final analysis. Reoperation occurred in 122 patients (0.7 %) and AKI in 96 patients (0.6 %). Higher total MAC<sub>hr</sub> exposure was independently associated with increased reoperation (OR 1.75, 95 % CI 1.35, 2.26; P < 0.001), and AKI (OR 1.35, 95 % CI 1.05, 1.70; P = 0.015). While isoflurane and sevoflurane showed comparable associations with reoperation risk, only sevoflurane increased AKI risk (OR 1.53, 95 % CI 1.20, 1.90; P < 0.001) versus no association with isoflurane (OR 0.89, 95 % CI 0.55, 1.38; P = 0.630), with a significant difference between these agents (P = 0.012).</p><p><strong>Conclusion: </strong>Cumulative volatile anaesthetic exposure was independently associated with increased postoperative complications following bariatric surgery. The association with reoperation rate appears to be a class effect, while sevoflurane, but not isoflurane, is associated with an increased risk of AKI. However, these observational associations may be influenced by residual confounding. These hypothesis-generating findings require prospective validation before clinical recommendations can be made.</p>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"107 ","pages":"112020"},"PeriodicalIF":5.1000,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The association between volatile anaesthetic exposure and postoperative complications following bariatric surgery: A multicentre retrospective cohort study.\",\"authors\":\"Karam Azem, Philip Heesen, Eitan Mangoubi, Sharon Orbach-Zinger, Roussana Aranbitski, Shai Fein, Benjamin Zribi\",\"doi\":\"10.1016/j.jclinane.2025.112020\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Despite the effectiveness of bariatric surgery for severe obesity, reoperation and acute kidney injury (AKI) remain significant complications. The impact of volatile anaesthetics on postoperative outcomes is unclear, and current guidelines lack evidence-based recommendations for anaesthetic selection. We investigated the association between cumulative volatile anaesthetic exposure and postoperative complications following bariatric surgery.</p><p><strong>Methods: </strong>This multicentre retrospective study included patients undergoing laparoscopic bariatric procedures at four Israeli centres (January 2017-May 2025). Volatile anaesthetic exposure was quantified as age-adjusted minimum alveolar concentration-hours (MAC<sub>hr</sub>). We examined associations with reoperation (within 30 days) and AKI (within 7 days) and compared agent-specific effects using mixed-effects logistic regression.</p><p><strong>Results: </strong>A total of 16,685 patients were included in the final analysis. Reoperation occurred in 122 patients (0.7 %) and AKI in 96 patients (0.6 %). Higher total MAC<sub>hr</sub> exposure was independently associated with increased reoperation (OR 1.75, 95 % CI 1.35, 2.26; P < 0.001), and AKI (OR 1.35, 95 % CI 1.05, 1.70; P = 0.015). While isoflurane and sevoflurane showed comparable associations with reoperation risk, only sevoflurane increased AKI risk (OR 1.53, 95 % CI 1.20, 1.90; P < 0.001) versus no association with isoflurane (OR 0.89, 95 % CI 0.55, 1.38; P = 0.630), with a significant difference between these agents (P = 0.012).</p><p><strong>Conclusion: </strong>Cumulative volatile anaesthetic exposure was independently associated with increased postoperative complications following bariatric surgery. The association with reoperation rate appears to be a class effect, while sevoflurane, but not isoflurane, is associated with an increased risk of AKI. However, these observational associations may be influenced by residual confounding. 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引用次数: 0
摘要
背景:尽管减肥手术对重度肥胖有疗效,但再手术和急性肾损伤(AKI)仍然是重要的并发症。挥发性麻醉剂对术后结果的影响尚不清楚,目前的指南缺乏基于证据的麻醉剂选择建议。我们调查了累积挥发性麻醉暴露与减肥手术后并发症之间的关系。方法:这项多中心回顾性研究纳入了2017年1月至2025年5月在以色列四个中心接受腹腔镜减肥手术的患者。挥发性麻醉暴露量化为年龄调整的最小肺泡浓度-小时(MAChr)。我们检查了再手术(30天内)和AKI(7天内)的相关性,并使用混合效应逻辑回归比较了药物特异性效应。结果:共纳入16685例患者。再手术122例(0.7%),AKI 96例(0.6%)。较高的总麻风暴露与再手术增加独立相关(OR 1.75, 95% CI 1.35, 2.26; P)结论:累积挥发性麻醉暴露与减肥手术后并发症增加独立相关。与再手术率的关联似乎是一类效应,而七氟醚(而非异氟醚)与AKI风险增加相关。然而,这些观察性关联可能受到残留混杂的影响。在提出临床建议之前,这些产生假设的发现需要前瞻性验证。
The association between volatile anaesthetic exposure and postoperative complications following bariatric surgery: A multicentre retrospective cohort study.
Background: Despite the effectiveness of bariatric surgery for severe obesity, reoperation and acute kidney injury (AKI) remain significant complications. The impact of volatile anaesthetics on postoperative outcomes is unclear, and current guidelines lack evidence-based recommendations for anaesthetic selection. We investigated the association between cumulative volatile anaesthetic exposure and postoperative complications following bariatric surgery.
Methods: This multicentre retrospective study included patients undergoing laparoscopic bariatric procedures at four Israeli centres (January 2017-May 2025). Volatile anaesthetic exposure was quantified as age-adjusted minimum alveolar concentration-hours (MAChr). We examined associations with reoperation (within 30 days) and AKI (within 7 days) and compared agent-specific effects using mixed-effects logistic regression.
Results: A total of 16,685 patients were included in the final analysis. Reoperation occurred in 122 patients (0.7 %) and AKI in 96 patients (0.6 %). Higher total MAChr exposure was independently associated with increased reoperation (OR 1.75, 95 % CI 1.35, 2.26; P < 0.001), and AKI (OR 1.35, 95 % CI 1.05, 1.70; P = 0.015). While isoflurane and sevoflurane showed comparable associations with reoperation risk, only sevoflurane increased AKI risk (OR 1.53, 95 % CI 1.20, 1.90; P < 0.001) versus no association with isoflurane (OR 0.89, 95 % CI 0.55, 1.38; P = 0.630), with a significant difference between these agents (P = 0.012).
Conclusion: Cumulative volatile anaesthetic exposure was independently associated with increased postoperative complications following bariatric surgery. The association with reoperation rate appears to be a class effect, while sevoflurane, but not isoflurane, is associated with an increased risk of AKI. However, these observational associations may be influenced by residual confounding. These hypothesis-generating findings require prospective validation before clinical recommendations can be made.
期刊介绍:
The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained.
The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.