Browsing by Author "Zunic J."

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    Association of preoperative smoking with the occurrence of postoperative pulmonary complications: A post hoc analysis of an observational study in 29 countries
    (2025-06-01) Dorland G.; Saadat W.; van Meenen D.M.P.; Neto A.S.; Hiesmayr M.; Hollmann M.W.; Mills G.H.; Vidal Melo M.F.; Putensen C.; Schmid W.; Severgnini P.; Wrigge H.; de Abreu M.G.; Schultz M.J.; Hemmes S.N.T.; Kroell W.; Metzler H.; Struber G.; Wegscheider T.; Gombotz H.; Hiesmayr M.; Schmid W.; Urbanek B.; Kahn D.; Momeni M.; Pospiech A.; Lois F.; Forget P.; Grosu I.; Poelaert J.; van Mossevelde V.; van Malderen M.C.; Dylst D.; van Melkebeek J.; Beran M.; de Hert S.; De Baerdemaeker L.; Heyse B.; Van Limmen J.; Wyffels P.; Jacobs T.; Roels N.; De Bruyne A.; van de Velde S.; Leva B.; Damster S.; Plichon B.; Juros-Zovko M.; Djonoviċ-Omanoviċ D.; Pernar S.; Zunic J.; Miskovic P.; Zilic A.; Kvolik S.; Ivic D.; Azenic-Venzera D.; Skiljic S.; Vinkovic H.; Oputric I.; Juricic K.; Frkovic V.; Kopic J.; Mirkovic I.; Karanovic N.; Carev M.; Dropulic N.; Saric J.P.; Erceg G.; Dvorscak M.B.; Mazul-Sunko B.; Pavicic A.M.; Goranovic T.; Maldini B.; Radocaj T.; Gavranovic Z.; Mladic-Batinica I.; Sehovic M.; Stourac P.; Harazim H.; Smekalova O.; Kosinova M.; Kolacek T.; Hudacek K.; Drab M.; Brujevic J.; Vitkova K.; Jirmanova K.; Volfova I.; Dzurnakova P.; Liskova K.; Dudas R.; Filipsky R.; el Kafrawy S.; Abdelwahab H.H.; Metwally T.; Abdel-Razek A.; El-Shaarawy A.M.; Hasan W.F.; Ahmed A.G.; Yassin H.; Dorland G.; Mahidol University
    Introduction: While smoking has been consistently identified as a significant contributor to postoperative complications, the existing literature on its association with postoperative pulmonary complications remains conflicting. Aim: We examined the association of preoperative smoking with the occurrence of postoperative pulmonary complications (PPCs). Methods: Post hoc analysis of an observational study in 146 hospitals across 29 countries. We included patients at increased risk of PPCs, according to the Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score (≥ 26 points). The primary endpoint was the occurrence of one or more predefined PPCs in the first five postoperative days, including unplanned postoperative need for supplementary oxygen, respiratory failure, unplanned need for invasive ventilation, ARDS, pneumonia and pneumothorax. Secondary endpoints included length of hospital stay and in–hospital mortality. We performed propensity score matching to correct for factors with a known association with postoperative outcomes. Results: Out of 2632 patients, 531 (20.2 %) patients were smokers and 2102 (79.8 %) non-smokers. At five days after surgery, 101 (19.0 %) smokers versus 404 (19.2) non–smokers had developed one or more PPCs (P = 0.95). Respiratory failure was more common in smokers (5.1 %) than non–smokers (3.0 %) (P = 0.02), while rates of other PPCs like need for supplementary oxygen, invasive ventilation, ARDS, pneumonia, or pneumothorax did not differ between the groups. Length of hospital stay and mortality was not different between groups. Propensity score matching did not change the findings. Conclusion: The occurrence of PPCs in smokers is not different from non–smokers. Funding: This analysis was performed without additional funding. LAS VEGAS was partially funded and endorsed by the European Society of Anaesthesiology through their Clinical Trial Network and the Amsterdam University Medical Centers, Amsterdam, The Netherlands. Registration: LAS VEGAS was registered at Clinicaltrials.gov (NCT01601223). Prior presentation: Preliminary study results have been presented at the Euroanaesthesia 2024 International Congress, in Munich, Germany.
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    Associations of intraoperative end–tidal CO2 levels with postoperative outcome–secondary analysis of a worldwide observational study
    (2025-02-01) Nasa P.; van Meenen D.M.P.; Paulus F.; de Abreu M.G.; Bossers S.M.; Schober P.; Schultz M.J.; Neto A.S.; Hemmes S.N.T.; Kroell W.; Metzler H.; Struber G.; Wegscheider T.; Gombotz H.; Hiesmayr M.; Schmid W.; Urbanek B.; Kahn D.; Momeni M.; Pospiech A.; Lois F.; Forget P.; Grosu I.; Poelaert J.; van Mossevelde V.; van Malderen M.C.; Dylst D.; van Melkebeek J.; Beran M.; de Hert S.; De Baerdemaeker L.; Heyse B.; Van Limmen J.; Wyffels P.; Jacobs T.; Roels N.; De Bruyne A.; van de Velde S.; Leva B.; Damster S.; Plichon B.; JurosZovko M.; Djonovic-Omanoviċ D.; Pernar S.; Zunic J.; Miskovic P.; Zilic A.; Kvolik S.; Ivic D.; Azenic-Venzera D.; Skiljic S.; Vinkovic H.; Oputric I.; Juricic K.; Frkovic V.; Kopic J.; Mirkovic I.; Karanovic N.; Carev M.; Dropulic N.; Saric J.P.; Erceg G.; Dvorscak M.B.; Mazul-Sunko B.; Pavicic A.M.; Goranovic T.; Maldini B.; Radocaj T.; Gavranovic Z.; Mladic-Batinica I.; Sehovic M.; Stourac P.; Harazim H.; Smekalova O.; Kosinova M.; Kolacek T.; Hudacek K.; Drab M.; Brujevic J.; Vitkova K.; Jirmanova K.; Volfova I.; Dzurnakova P.; Liskova K.; Dudas R.; Filipsky R.; El Kafrawy S.; Abdelwahab H.H.; Metwally T.; Abdel-Razek A.; El-Shaarawy A.M.; Hasan W.F.; Ahmed A.G.; Yassin H.; Magdy M.; Abdelhady M.; Mahran M.; Herodes E.; Kivik P.; Oganjan J.; Nasa P.; Mahidol University
    Background: Patients receiving intraoperative ventilation during general anesthesia often have low end–tidal CO2 (etCO2). We examined the association of intraoperative etCO2 levels with the occurrence of postoperative pulmonary complications (PPCs) in a conveniently–sized international, prospective study named ‘Local ASsessment of Ventilatory management during General Anesthesia for Surgery’ (LAS VEGAS). Methods: Patients at high risk of PPCs were categorized as ‘low etCO2’ or ‘normal to high etCO2’ patients, using a cut–off of 35 mmHg. The primary endpoint was a composite of previously defined PPCs; the individual PPCs served as secondary endpoints. The need for unplanned oxygen was defined as mild PPCs and severe PPCs included pneumonia, respiratory failure, acute respiratory distress syndrome, barotrauma, and new invasive ventilation. We performed propensity score matching and LOESS regression to evaluate the relationship between the lowest etCO2 and PPCs. Results: The analysis included 1843 (74 %) ‘low etCO2’ patients and 648 (26 %) ‘normal to high etCO2’ patients. There was no difference in the occurrence of PPCs between ‘low etCO2’ and ‘normal to high etCO2’ patients (20 % vs. 19 %; RR 1.00 [95 %–confidence interval 0.94 to 1.06]; P = 0.84). The proportion of severe PPCs among total occurring PPCs, were higher in ‘low etCO2’ patients compared to ‘normal to high etCO2’ patients (35 % vs. 18 %; RR 1.16 [1.08 to 1.25]; P < 0.001). Propensity score matching did not change these findings. LOESS plot showed an inverse relationship of intraoperative etCO2 levels with the occurrence of PPCs. Conclusions: In this cohort of patients at high risk of PPCs, the overall occurrence of PPCs was not different between ‘low etCO2’ patients and ‘normal to high etCO2’ patients, but severe PPCs occurred more often in ‘low etCO2’, with an inverse dose–dependent relationship between intraoperative etCO2 levels and PPCs. Funding: This analysis was performed without additional funding. LAS VEGAS was partially funded and endorsed by the European Society of Anesthesiology and Intensive Care (ESAIC) and the Amsterdam University Medical Centers, location ‘AMC’. Registration: LAS VEGAS was registered at Clinicaltrials.gov (NCT01601223), first posted on May 17, 2012.
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    Pulmonary complications following urological, gastrointestinal and gynaecological abdominal Surgery––A post-hoc analysis of an observational study in 29 countries
    (2026-01-01) Vermeulen T.D.; Hemmes S.N.T.; Blok S.; Schultz M.J.; Hiesmayr M.; Mills G.H.; Putensen C.; Schmid W.; Serpa Neto A.; Severgnini P.; Vidal Melo M.F.; Wrigge H.; Hollmann M.W.; Gama de Abreu M.; van Meenen D.M.P.; Hemmes S.N.T.; Neto A.S.; Binnekade J.M.; Canet J.; Hedenstierna G.; Jaber S.; Hiesmayr M.; Hollmann M.W.; Mills G.H.; Vidal Melo M.F.; Pearse R.; Putensen C.; Schmid W.; Severgnini P.; Wrigge H.; de Abreu M.G.; Pelosi P.; Schultz M.J.; Kroell W.; Metzler H.; Struber G.; Wegscheider T.; Gombotz H.; Hiesmayr M.; Schmid W.; Urbanek B.; Kahn D.; Momeni M.; Pospiech A.; Lois F.; Forget P.; Grosu I.; Poelaert J.; van Mossevelde V.; van Malderen M.C.; Dylst D.; van Melkebeek J.; Beran M.; de Hert S.; De Baerdemaeker L.; Heyse B.; Van Limmen J.; Wyffels P.; Jacobs T.; Roels N.; De Bruyne A.; van de Velde S.; Juros-Zovko M.; Djonoviċ- Omanoviċ D.; Pernar S.; Zunic J.; Miskovic P.; Zilic A.; Kvolik S.; Ivic D.; Azenic-Venzera D.; Skiljic S.; Vinkovic H.; Oputric I.; Juricic K.; Frkovic V.; Kopic J.; Mirkovic I.; Karanovic N.; Carev M.; Dropulic N.; Pavicic Saric J.; Erceg G.; Bogdanovic Dvorscak M.; Mazul-Sunko B.; Marija Pavicic A.; Goranovic T.; Maldini B.; Radocaj T.; Gavranovic Z.; Mladic-Batinica I.; Sehovic M.; Stourac P.; Harazim H.; Smekalova O.; Kosinova M.; Kolacek T.; Hudacek K.; Drab M.; Brujevic J.; Vermeulen T.D.; Mahidol University
    BackgroundThe incidence of postoperative pulmonary complications (PPCs33Postoperative Pulmonary Complications.) following abdominal surgery varies across surgical specialties. It remains unclear to what extent the incidence of PPCs is attributable to known patient–related factors and anaesthesia duration, rather than to differences inherent to the surgical specialty itself.MethodsPost-hoc analysis of an observational study describing postoperative outcomes in patients undergoing urological, gastrointestinal, and gynaecological abdominal surgery. The primary endpoint was a composite measure of PPCs. Secondary endpoints included the individual incidence of each PPC. Propensity score weighting was used to create a cohort with similar patient characteristics and anaesthesia duration.ResultsThe cohort consisted of 3306 patients across 146 centres in 29 countries–367 underwent urological surgery, 2100 underwent gastrointestinal surgery, and 839 underwent gynaecological surgery. Risk scores for PPCs were highest in urological surgical patients, followed by gastrointestinal and gynaecological surgical patients. PPCs also occurred most often after urological surgery (17.7%), followed by gastrointestinal (14.9%) and gynaecological surgery (9.8%) (p < 0.001). After weighting, these differences in incidence disappeared, with comparable rates across the three groups (urological surgery 15.7%, gastrointestinal 14.5%, gynaecological 12.2%; p = 0.340). Apart from unplanned supplementary oxygen, all PPCs were most frequent after gastrointestinal surgery and least common following gynaecological surgery.ConclusionsIn this worldwide cohort of patients undergoing abdominal surgery, the incidence of PPCs varied across urological, gastrointestinal, and gynaecological surgery; the differences in incidence may be more strongly influenced by patient–related factors and anaesthesia duration than by the characteristics of the surgical specialty itself. Gastrointestinal surgeries showed the highest rates of severe PPCs.
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    Sex dependence of postoperative pulmonary complications – A post hoc unmatched and matched analysis of LAS VEGAS
    (2024-12-01) Vermeulen T.D.; Hol L.; Swart P.; Hiesmayr M.; Mills G.H.; Putensen C.; Schmid W.; Serpa Neto A.; Severgnini P.; Vidal Melo M.F.; Wrigge H.; Hollmann M.W.; Gama de Abreu M.; Schultz M.J.; Hemmes S.N.; van Meenen D.M.; Kroell W.; Metzler H.; Struber G.; Wegscheider T.; Gombotz H.; Urbanek B.; Kahn D.; Momeni M.; Pospiech A.; Lois F.; Forget P.; Grosu I.; Poelaert J.; van Mossevelde V.; van Malderen M.C.; Dylst D.; van Melkebeek J.; Beran M.; de Hert S.; De Baerdemaeker L.; Heyse B.; Van Limmen J.; Wyffels P.; Jacobs T.; Roels N.; De Bruyne A.; van de Velde S.; Leva B.; Damster S.; Plichon B.; Juros-Zovko M.; Djonoviċ-Omanoviċ D.; Pernar S.; Zunic J.; Miskovic P.; Zilic A.; Kvolik S.; Ivic D.; Azenic-Venzera D.; Skiljic S.; Vinkovic H.; Oputric I.; Juricic K.; Frkovic V.; Kopic J.; Mirkovic I.; Karanovic N.; Carev M.; Dropulic N.; Saric J.P.; Erceg G.; Dvorscak M.B.; Mazul-Sunko B.; Pavicic A.M.; Goranovic T.; Maldini B.; Radocaj T.; Gavranovic Z.; Mladic-Batinica I.; Sehovic M.; Stourac P.; Harazim H.; Smekalova O.; Kosinova M.; Kolacek T.; Hudacek K.; Drab M.; Brujevic J.; Vitkova K.; Jirmanova K.; Volfova I.; Dzurnakova P.; Liskova K.; Dudas R.; Filipsky R.; el Kafrawy S.; Abdelwahab H.H.; Metwally T.; Abdel-Razek A.; El-Shaarawy A.M.; Hasan W.F.; Ahmed A.G.; Yassin H.; Magdy M.; Vermeulen T.D.; Mahidol University
    Study objective: Male sex has inconsistently been associated with the development of postoperative pulmonary complications (PPCs). These studies were different in size, design, population and preoperative risk. We reanalysed the database of ‘Local ASsessment of Ventilatory management during General Anaesthesia for Surgery study’ (LAS VEGAS) to evaluate differences between females and males with respect to PPCs. Design, setting and patients: Post hoc unmatched and matched analysis of LAS VEGAS, an international observational study in patients undergoing intraoperative ventilation under general anaesthesia for surgery in 146 hospitals across 29 countries. The primary endpoint was a composite of PPCs in the first 5 postoperative days. Individual PPCs, hospital length of stay and mortality were secondary endpoints. Propensity score matching was used to create a similar cohort regarding type of surgery and epidemiological factors with a known association with development of PPCs. Main results: The unmatched cohort consisted of 9697 patients; 5342 (55.1%) females and 4355 (44.9%) males. The matched cohort consisted of 6154 patients; 3077 (50.0%) females and 3077 (50.0%) males. The incidence in PPCs was neither significant between females and males in the unmatched cohort (10.0 vs 10.7%; odds ratio (OR) 0.93 [0.81–1.06]; P = 0.255), nor in the matched cohort (10.5 vs 10.0%; OR 1.05 [0.89–1.25]; P = 0.556). New invasive ventilation occurred less often in females in the unmatched cohort. Hospital length of stay and mortality were similar between females and males in both cohorts. Conclusions: In this conveniently–sized worldwide cohort of patients receiving intraoperative ventilation under general anaesthesia for surgery, the PPC incidence was not significantly different between sexes. Registration: LAS VEGAS was registered at clinicaltrial.gov (study identifier NCT01601223).