• Hiroki Ogata, Yuka Matsuki, Takuma Okamoto, Ryusuke Ueki, Nobutaka Kariya, Tsuneo Tatara, Kenji Shigemi, and Munetaka Hirose.
• From the Department of Anaesthesiology and Pain Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo (HO, TO, RU, NK, TT, MH), the Department of Anaesthesiology & Reanimatology, Faculty of Medicine Sciences, University of Fukui, Eiheiji-cho, Fukui, Japan (YM, KS).
• Eur J Anaesthesiol. 2021 Dec 1; 38 (12): 121512221215-1222.

BackgroundSurgical procedures stimulate nociception and induce physiological responses according to the balance between nociception and antinociception. The severity of surgical stimuli is associated with major postoperative complications. Although an intra-operative quantitative index representing surgical invasiveness would be useful for anaesthetic management to predict and prevent major complications, no such index is available.ObjectivesTo identify associations between major complications after gastrointestinal surgery and intra-operative quantitative values from intra-operative nociception monitoring.DesignA multi-institutional observational study.SettingTwo university hospitals.PatientsConsecutive adult patients undergoing gastrointestinal surgery under general anaesthesia.Main Outcome MeasuresAveraged values of nociceptive response index from start to end of surgery (mean NR index) and risk scores of the Surgical Mortality Probability Model (S-MPM) were calculated. Pre and postoperative serum C-reactive protein (CRP) levels were obtained. After receiver-operating characteristic (ROC) curve analysis, all patients were divided into groups with high and low mean nociceptive response index. Associations between mean nociceptive response index and postoperative major complications, defined as Clavien-Dindo grade at least IIIa, were examined using logistic regression analysis.ResultsROC curve analysis showed a nociceptive response index cut-off value for major complications of 0.83, and we divided patients into two groups with mean nociceptive response index less than 0.83 and at least 0.83. The incidence of major complications was significantly higher in patients with mean nociceptive response index at least 0.83 (23.1%; n = 346) than in patients with mean nociceptive response index less than 0.83 (7.7%; n = 443; P < 0.001). Multivariate analysis revealed emergency surgery, S-MPM risk score, mean nociceptive response index and postoperative CRP levels as independent risk factors for major complications.ConclusionMean nociceptive response index during surgery likely correlates with major complications after gastrointestinal surgery.Trial RegistrationThe current observational study had no intervention, and was therefore, not registered.Copyright © 2021 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.

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