Guido MazzinariAry Serpa NetoSabrine N.T. HemmesGoran HedenstiernaSamir JaberMichael HiesmayrMarkus W. HollmannGary H. MillsMarcos F. Vidal MeloRupert M. PearseChristian PutensenWerner SchmidPaolo SevergniniHermann WriggeOscar Diaz CambroneroLorenzo BallMarcelo Gama de AbreuPaolo PelosiMarcus J. SchultzWolfgang KroellHelfried MetzlerGerd StruberThomas WegscheiderHans GombotzBernhard UrbanekDavid KahnMona MomeniAudrey PospiechFernande LoisPatrice ForgetIrina GrosuJan PoelaertVeerle van MosseveldeMarie Claire van MalderenDimitri DylstJeroen van MelkebeekMaud BeranStefan de HertLuc De BaerdemaekerBjorn HeyseJurgen Van LimmenPiet WyffelsTom JacobsNathalie RoelsAnn De BruyneStijn van de VeldeBrigitte LevaSandrine DamsterBenoit PlichonMarina Juros-ZovkoDejana Djonovic-OmanovicSelma PernarJosip ZunicPetar MiskovicAntonio ZilicSlavica KvolikDubravka IvicDarija Azenic-VenzeraSonja SkiljicHrvoje VinkovicIvana OputricKazimir JuricicVedran FrkovicJasminka KopicIvan MirkovicNenad KaranovicMladen CarevNatasa DropulicJadranka Pavicic SaricGorjana ErcegMatea Bogdanovic DvorscakBranka Mazul-SunkoAnna Marija PavicicTanja GoranovicBranka MaldiniTomislav RadocajZeljka GavranovicInga Mladic-BatinicaMirna SehovicPetr StouracHana HarazimOlga SmekalovaMartina KosinovaTomas KolacekKamil HudacekMichal DrabJan BrujevicKaterina VitkovaKaterina JirmanovaIvana VolfovaPaula DzurnakovaKatarina LiskovaRadovan DudasRadek FilipskySamir el KafrawyHisham Hosny AbdelwahabTarek MetwallyAhmed Abdel-RazekAhmed Mostafa El-ShaarawyWael Fathy HasanUniversité de MontpellierIRCCS San Martino Polyclinic HospitalHospital Universitari i Politècnic La FeUniversitätsklinikum BonnMassachusetts General HospitalUniversità degli Studi di GenovaQueen Mary University of LondonTechnische Universität DresdenHospital Israelita Albert EinsteinMahidol UniversityMedizinische Universität WienNuffield Department of MedicineUniversidade de São PauloBG-Kliniken Bergmannstrost HalleUniversità degli Studi dell'InsubriaUppsala UniversitetThe University of SheffieldAmsterdam UMC - University of Amsterdam2022-08-042022-08-042021-12-01BMC Anesthesiology. Vol.21, No.1 (2021)147122532-s2.0-85102932125https://repository.li.mahidol.ac.th/handle/20.500.14594/77618Background: It is uncertain whether the association of the intraoperative driving pressure (ΔP) with postoperative pulmonary complications (PPCs) depends on the surgical approach during abdominal surgery. Our primary objective was to determine and compare the association of time–weighted average ΔP (ΔPTW) with PPCs. We also tested the association of ΔPTW with intraoperative adverse events. Methods: Posthoc retrospective propensity score–weighted cohort analysis of patients undergoing open or closed abdominal surgery in the ‘Local ASsessment of Ventilatory management during General Anaesthesia for Surgery’ (LAS VEGAS) study, that included patients in 146 hospitals across 29 countries. The primary endpoint was a composite of PPCs. The secondary endpoint was a composite of intraoperative adverse events. Results: The analysis included 1128 and 906 patients undergoing open or closed abdominal surgery, respectively. The PPC rate was 5%. ΔP was lower in open abdominal surgery patients, but ΔPTW was not different between groups. The association of ΔPTW with PPCs was significant in both groups and had a higher risk ratio in closed compared to open abdominal surgery patients (1.11 [95%CI 1.10 to 1.20], P < 0.001 versus 1.05 [95%CI 1.05 to 1.05], P < 0.001; risk difference 0.05 [95%CI 0.04 to 0.06], P < 0.001). The association of ΔPTW with intraoperative adverse events was also significant in both groups but had higher odds ratio in closed compared to open abdominal surgery patients (1.13 [95%CI 1.12– to 1.14], P < 0.001 versus 1.07 [95%CI 1.05 to 1.10], P < 0.001; risk difference 0.05 [95%CI 0.030.07], P < 0.001). Conclusions: ΔP is associated with PPC and intraoperative adverse events in abdominal surgery, both in open and closed abdominal surgery. Trial registration: LAS VEGAS was registered at clinicaltrials.gov (trial identifier NCT01601223).Mahidol UniversityMedicineArticleSCOPUS10.1186/s12871-021-01268-y