• Stéphane Bar, Mouhamed Djahoum Moussa, Richard Descamps, Younes El Amine, Belaid Bouhemad, Marc-Olivier Fischer, Emmanuel Lorne, Hervé Dupont, Momar Diouf, Pierre Grégoire Guinot, and OPHIQUE study group.
• Department of Anesthesiology and Critical Care Medicine, Amiens University Medical Centre, Amiens, France; SSPC UPJV 7518 (Simplifications des Soins Patients Chirurgicaux Complexes - Simplification of Care of Complex Surgical Patients) Clinical Research Unit, Jules Verne University of Picardie, Amiens, France. Electronic address: bar.stephane@chu-amiens.fr.
• J Clin Anesth. 2024 May 1; 93: 111325111325.

Study ObjectiveThis post-hoc analysis of a randomized controlled trial was undertaken to establish the determinants of postoperative complications and acute kidney injury in high-risk noncardiac surgery patients supported with hemodynamic treatment strategies.DesignWe conducted a post-hoc analysis of patients enrolled in the OPtimization Hemodynamic Individualized by the respiratory QUotiEnt (OPHIQUE) trial.SettingOperating rooms in four university medical centers and one non-university hospital from December 26, 2018, to September 9, 2021.PatientsWe enrolled 350 patients with a high risk of postoperative complications undergoing high-risk noncardiac surgery lasting 2 h or longer under general anesthesia.InterventionsAll patients were treated according to hemodynamic treatment strategies which included cardiac output optimization by titration of fluid challenge and targeted systolic blood pressure to remain within ±10% of the reference value.MeasurementsWe assessed the association between pre-operative and intra-operative exposure of interest with a composite primary outcome of major complications or death within seven days following surgery using a multivariable logistic regression model. We also assessed the association between these exposures of interest and acute kidney injury.Main ResultsThe data of 341 patients were analyzed. In multivariate analysis, the factors independently associated with the primary outcome were age (OR = 1.04 (1.01-1.06), P = 0.002), preoperative hemoglobin concentration (OR = 0.85 (0.75-0.96), P = 0.012), non-vascular surgery (OR = 0.30 (0.17-0.53), P < 0.0001), and intraoperative surgical complications (OR = 2.08 (1.02-4.24), P = 0.046). The factors independently associated with postoperative acute kidney injury were age (OR = 1.04 (1.01-1.08), P = 0.008), preoperative creatinine concentration (OR = 1.01 (1.00-1.01), P = 0.049), non-vascular surgery (OR = 0.36 (0.20-0.66), P = 0.001), and intraoperative surgical complications (OR = 3.36 (1.50-7.55), P = 0.031).ConclusionsSurgical complications, a lower preoperative hemoglobin concentration, age, and vascular surgery were associated with postoperative complications in a high-risk noncardiac surgery population supported with hemodynamic treatment strategies.Copyright © 2023 Elsevier Inc. All rights reserved.

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