The Association Between Arterial Pulse Waveform Analysis Device and In-Hospital Mortality in High-Risk Non-Cardiac Surgeries
Background: Perioperative goal-directed fluid therapy is used for haemodynamic optimisation in high-risk surgeries. Cardiac output monitoring can be performed by a specialised pressure transducer for arterial pulse waveform analysis (S-APWA).No study has assessed whether real-world use of S-APWA is associated with postoperative outcomes; therefore, using a Japanese administrative claims database, we retrospectively investigated whether S-APWA use is associated with in-hospital mortality among patients undergoing high-risk surgery under general anaesthesia.
Methods: Adult patients who underwent high-risk surgery under general anaesthesia and arterial catheterisation between 2014 and 2016 were divided into S-APWA and conventional arterial pressure transducer groups, then compared regarding baseline factors and outcomes. Logistic regression analysis was performed to compare in-hospital mortality. Subgroup analyses evaluated S-APWA efficacy and outcomes based on the type of surgery and patients’ comorbidity.
Results: S-APWA was used in 6,859 of 23,655 (29.0%) patients; the crude in-hospital mortality rate was 3.5%. Adjusted analysis showed no significant association between S-APWA use and in-hospital mortality rate (adjusted odds ratio [aOR]=0.91; 95% confidence interval [CI]: 0.76–1.07; P=0.25). S-APWA use was associated with significantly lower in-hospital mortality in patients undergoing vascular surgery (aOR=0.67; 95%CI: 0.49–0.94), and significantly higher in-hospital mortality in patients undergoing lower limb amputation (aOR=2.63; 95%CI: 1.32–5.22). S-APWA use and in-hospital mortality were not significantly associated in other subgroups.
Conclusion: S-APWA use was not associated with in-hospital mortality in the entire study population. However, S-APWA was associated with decreased in-hospital mortality among vascular surgery and increased in-hospital mortality among lower limb amputation.