• Liselotte Hol, Sunny G L H Nijbroek, NetoAry SerpaASDepartment of Intensive Care, Amsterdam UMC, location AMC, Amsterdam, The Netherlands.Department of Critical Care Medicine, Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Monash University, Melbourne, Australia., HemmesSabrine N TSNTDepartment of Anesthesiology, Amsterdam UMC, location AMC, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands., Goran Hedenstierna, Michael Hiesmayr, Markus W Hollmann, Gary H Mills, Vidal MeloMarcos FMFDepartment of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA., Christian Putensen, Werner Schmid, Paolo Severgnini, Hermann Wrigge, Marcelo Gama de Abreu, Paolo Pelosi, Marcus J Schultz, and LAS VEGAS study–investigators.
• Department of Anesthesiology, Amsterdam UMC, location AMC, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands. l.hol@amsterdamumc.nl.
• BMC Anesthesiol. 2022 Jan 7; 22 (1): 15.

BackgroundThe aim of this analysis is to determine geo-economic variations in epidemiology, ventilator settings and outcome in patients receiving general anesthesia for surgery.MethodsPosthoc analysis of a worldwide study in 29 countries. Lower and upper middle-income countries (LMIC and UMIC), and high-income countries (HIC) were compared. The coprimary endpoint was the risk for and incidence of postoperative pulmonary complications (PPC); secondary endpoints were intraoperative ventilator settings, intraoperative complications, hospital stay and mortality.ResultsOf 9864 patients, 4% originated from LMIC, 11% from UMIC and 85% from HIC. The ARISCAT score was 17.5 [15.0-26.0] in LMIC, 16.0 [3.0-27.0] in UMIC and 15.0 [3.0-26.0] in HIC (P = .003). The incidence of PPC was 9.0% in LMIC, 3.2% in UMIC and 2.5% in HIC (P < .001). Median tidal volume in ml kg- 1 predicted bodyweight (PBW) was 8.6 [7.7-9.7] in LMIC, 8.4 [7.6-9.5] in UMIC and 8.1 [7.2-9.1] in HIC (P < .001). Median positive end-expiratory pressure in cmH2O was 3.3 [2.0-5.0]) in LMIC, 4.0 [3.0-5.0] in UMIC and 5.0 [3.0-5.0] in HIC (P < .001). Median driving pressure in cmH2O was 14.0 [11.5-18.0] in LMIC, 13.5 [11.0-16.0] in UMIC and 12.0 [10.0-15.0] in HIC (P < .001). Median fraction of inspired oxygen in % was 75 [50-80] in LMIC, 50 [50-63] in UMIC and 53 [45-70] in HIC (P < .001). Intraoperative complications occurred in 25.9% in LMIC, in 18.7% in UMIC and in 37.1% in HIC (P < .001). Hospital mortality was 0.0% in LMIC, 1.3% in UMIC and 0.6% in HIC (P = .009).ConclusionThe risk for and incidence of PPC is higher in LMIC than in UMIC and HIC. Ventilation management could be improved in LMIC and UMIC.Trial RegistrationClinicaltrials.gov , identifier: NCT01601223.© 2022. The Author(s).

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