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  3. Win Ratio approach for the composite outcome of postoperative pulmonary complications: Secondary analysis of a harmonised and pooled database of three randomised clinical trials

Win Ratio approach for the composite outcome of postoperative pulmonary complications: Secondary analysis of a harmonised and pooled database of three randomised clinical trials

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Autores de IIS La Fe

Participantes ajenos a IIS La Fe

  • Serpa Neto A.
  • Campos N.S.
  • Bluth T.
  • Hemmes S.N.T.
  • Ferrando C.
  • Librero J.
  • Soro M.
  • Ball L.
  • De Abreu M.G.
  • Schultz M.J.

Grupos

Abstract

BACKGROUNDThe win ratio analysis method might provide new insight on the impact of positive end-expiratory pressure (PEEP) on clinical outcomes.OBJECTIVEThe aim is to re-analyse the results of the 'Re-evaluation of the effects of high PEEP with recruitment manoeuvres vs. low PEEP without recruitment manoeuvres during general anaesthesia for surgery' (REPEAT) study using the win ratio analysis.DESIGNIndividual patient data meta-analysis.SETTINGThree international multicentre randomised trials.PARTICIPANTSPatients undergoing general anaesthesia for surgery.INTERVENTIONHigh vs. low PEEP.MAIN OUTCOME MEASUREHierarchical composite endpoint of: all-cause hospital mortality; hospital length of stay; need for postoperative mechanical ventilation; severe pulmonary complications; and mild pulmonary complications.RESULTSA total of 3774 patients undergoing general anaesthesia for surgery were included in this analysis. The median (interquartile range [IQR]) age was 57 [45 to 68] years and 2077 (55%) were women. A total of 3 560 720 comparison pairs were produced. The high PEEP group had a higher percentage of losses than wins in hospital mortality (1.1 vs. 0.9%) and hospital length of stay (33.8 vs. 33.2%), comparable percentages of losses and wins in postoperative invasive mechanical ventilation (0.2 vs. 0.2%), a higher percentage of wins in severe complications (2.5 vs. 2.1%) and a higher percentage of ties in mild complications (18.7 vs. 3.9% wins vs. 3.3% losses). The win ratio for high PEEP compared with low PEEP group was 1.00 (95% CI 0.92 to 1.09).CONCLUSIONNo beneficial effects of high PEEP compared with low PEEP were found in this win ratio analysis.REGISTRATIONClinicaltrials.gov (study identifier NCT03937375). Copyright © 2024 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.

Copyright © 2024 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.

Datos de la publicación

ISSN/ISSNe:
0265-0215, 1365-2346

EUROPEAN JOURNAL OF ANAESTHESIOLOGY  LIPPINCOTT WILLIAMS & WILKINS

Tipo:
Article
Páginas:
340-346
PubMed:
39698861
Enlace a otro recurso:
www.scopus.com
Factor de Impacto:
0,979 SCImago ℠
Cuartil:
Q1 SCImago ℠

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Keywords

  • Aged; Anesthesia, General; Databases, Factual; Female; Hospital Mortality; Humans; Length of Stay; Lung Diseases; Male; Middle Aged; Positive-Pressure Respiration; Postoperative Complications; Randomized Controlled Trials as Topic; Respiration, Artificial; Treatment Outcome; adult; Article; artificial ventilation; clinical outcome; female; general anesthesia; hospital mortality; human; in-hospital mortality; invasive ventilation; length of stay; lung complication; major clinical study; male; meta analysis; patient coding; positive end expiratory pressure ventilation; postoperative lung complication; randomized controlled trial; secondary analysis; sensitivity analysis; adverse event; aged; epidemiology; etiology; factual database; hospital mortality; length of stay; lung disease; middle aged; positive pressure ventilation; postoperative complication; procedures; randomized controlled trial (topic); treatment outcome

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