Journal Article Multicenter Study Ppublish
PubMed: 42860683 DOI: 10.1111/aas.70355
Postoperative Vasoactive Exposure Patterns and Outcomes After Non-Cardiac Surgery: A Prespecified Analysis of the SQUEEZE Cohort.
Acta Anaesthesiol Scand 70(10):e70355
Authors: Javier Ripollés-Melchor, Ib Jammer, Ben Creagh-Brown, M Ignacio Monge-García, Ángel V Espinosa, Ane Abad-Motos, Rosalía Navarro-Pérez, Rachel Budithi, Alfredo Abad-Gurumeta, César Aldecoa
Affiliations
- Department of Anaesthesiology, Hospital Universitario Infanta Leonor, Madrid, Spain.
- Universidad Complutense de Madrid, Madrid, Spain.
- Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anaesthesiology and Reanimation (SEDAR), Madrid, Spain.
- Department of Anaesthesiology and Intensive Care, Haukeland University Hospital, Bergen, Norway.
- Department of Anaesthesiology, Royal Surrey County Hospital, Guildford, UK. School of Medicine, University of Surrey, Guildford, UK.
- Department of Intensive Care, Hospital Universitario Puerto Real, Cádiz, Spain.
- Department of Anaesthesiology, Froedtert Hospital Medical College of Wisconsin, Milwaukee, USA.
- Department of Anaesthesiology, Hospital Universitario Donostia, San Sebastian, Spain.
- Hospital Clínico San Carlos, Madrid, Spain.
- Department of Anaesthesiology, Hospital Universitario Río Hortega, Valladolid, Spain.
- Instituto de Investigación Biosanitaria de Valladolid (IBioVALL), Valladolid, Spain.
Abstract
BACKGROUND
Postoperative vasoactive therapy is usually summarised by its presence or duration, although haemodynamic support evolves over time. We investigated whether reproducible postoperative vasoactive exposure patterns provide prognostic information beyond the duration of postoperative vasoactive therapy.
METHODS
We performed a prespecified substudy of the international SQUEEZE cohort. Adults receiving postoperative vasoactive infusion within seven postoperative days after non-cardiac surgery were included. Unsupervised k-means clustering identified exposure patterns using duration of postoperative vasoactive infusion, cumulative vasoactive agent-days, and peak number of concurrent agents. Associations with 30-day mortality, acute kidney injury (AKI), and hospital length of stay were assessed using multivariable regression. A prespecified landmark analysis evaluated early postoperative vasoactive exposure burden during postoperative days 0-1.
RESULTS
Among 25,672 patients, 6676 (26.0%) received postoperative vasoactive infusion. Four reproducible exposure patterns were identified. Adjusted 30-day mortality ranged from 9.7% in the low-burden pattern to 35.3% in the high-burden pattern but was not strictly monotonic, whereas adjusted AKI risk increased from 28.0% to 56.0% across patterns. In covariate-adjusted models fitted to the same complete-case cohort, discrimination was higher when exposure pattern rather than duration was included (AUC 0.818 vs. 0.795), while adding duration to pattern classification resulted in little additional discrimination (AUC 0.819). Findings were consistent in the early postoperative landmark analysis.
CONCLUSIONS
Postoperative vasoactive exposure follows reproducible patterns characterised by persistence and overall treatment burden rather than binary classification alone. These patterns were associated with mortality, AKI, and hospital length of stay, and provided prognostic information beyond duration alone.
EDITORIAL COMMENT
This substudy and analysis of the SQUEEZE cohort, which represents a large sample of cases with focus on post-operative vasopressor treatments, shows that more intensive vasopressor therapy was associated with worse postoperative outcomes, including for mortality and 30 days and postoperative acute kidney injury occurrence.
TRIAL REGISTRATION
ClinicalTrials.gov identifier: NCT03805230.
MeSH
Mortality, Anesthesiology, Classification, Kidney, Length Of Stay, Cluster Analysis, Postoperative Period, Therapeutics, Hemodynamics, Acute Kidney Injury, Vasoconstrictor Agents