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Updated: Jun 4, 2026
Non-Intubated Video-Assisted Thoracoscopic Surgery
Published on: May 26, 2023
Intraoperative mechanical power and postoperative pulmonary complications: association and threshold analysis in
Mohamad El-Khatib1, Thuraya HajAli1, Carine Zeeni1
1Department of Anesthesiology and Pain Medicine, American University of Beirut Medical Centre, Beirut, Lebanon.
Background:
Postoperative pulmonary complications (PPCs) contribute to perioperative morbidity and mortality. Mechanical powers (MPs) determined using different deviations from originally described MP have been shown to be associated with PPCs. We aimed to evaluate the association between a standardized derivation of MP and PPCs and to explore a threshold associated with increased risk in multicentre cohort of adults undergoing intra-abdominal surgery.
Methods:
Data on adult patients who underwent intra-abdominal surgery under general anaesthesia were obtained from the Multicentre Perioperative Outcomes Group registry. The primary outcome was a composite of PPCs comprising an expanded subset of diagnoses consistent with European Perioperative Clinical Outcome definitions. The association between intraoperative MP and PPCs was evaluated using multivariable logistic regression, adjusting for patient, surgical, and institutional factors.
Results:
Among 79,149 patients from 56 institutions, 4,812 (6.1%) developed PPCs. Each 1 J/ min increase in MP was associated with 5% higher odds of PPCs (OR = 1.05, 95% CI [1.05-1.06]; p < 0.0001). Receiver operating characteristic analysis identified a threshold of 12 J/ min (sensitivity = 0.54, specificity = 0.51), above which patients had 54% higher adjusted odds of PPCs (ORadj = 1.54, 95% CI [1.42-1.66]; p < 0.0001).
Conclusions:
Higher MP was associated with increased risk of PPCs in patients undergoing intra-abdominal surgery. Although MP values above 12 J min⁻1 were associated with significantly increased odds of PPCs, this threshold demonstrated notably low standalone discriminatory performance. Further research is required to evaluate whether MP-directed lung-protective ventilation strategy could prospectively improve clinical outcomes. RESEARCH REGISTRATION NUMBER: https://doi.org/10.17605/OSF.IO/WRQ6B .
Insights
Higher mechanical power (MP) during surgery increases the risk of postoperative pulmonary complications (PPCs). A threshold of 12 J/min for MP was associated with significantly higher odds of PPCs in patients undergoing intra-abdominal surgery.
Area of Science:
- Anesthesiology
- Critical Care Medicine
- Thoracic Surgery
Background:
- Postoperative pulmonary complications (PPCs) are a significant cause of perioperative morbidity and mortality.
- Previous studies suggest associations between mechanical power (MP) variations and PPCs.
- A standardized MP derivation requires evaluation for its link to PPCs.
Purpose of the Study:
- To assess the association between a standardized mechanical power (MP) derivation and postoperative pulmonary complications (PPCs).
- To identify a potential threshold of MP associated with increased PPC risk.
- To investigate these associations in a multicenter cohort of adults undergoing intra-abdominal surgery.
Main Methods:
- Utilized data from the Multicenter Perioperative Outcomes Group registry for adult patients undergoing intra-abdominal surgery under general anesthesia.
- Defined the primary outcome as a composite of PPCs based on European Perioperative Clinical Outcome definitions.
- Employed multivariable logistic regression to analyze the association between intraoperative MP and PPCs, adjusting for relevant covariates.
Main Results:
- A total of 79,149 patients from 56 institutions were analyzed, with 6.1% experiencing PPCs.
- Each 1 J/min increase in MP correlated with a 5% higher likelihood of PPCs (OR=1.05).
- A threshold of 12 J/min for MP was identified, above which adjusted odds of PPCs increased by 54% (ORadj=1.54).
Conclusions:
- Elevated mechanical power (MP) is linked to a greater risk of PPCs in patients undergoing intra-abdominal surgery.
- While MP values exceeding 12 J/min showed a significant association with increased PPC odds, their standalone discriminatory power was limited.
- Further research is warranted to determine if an MP-guided lung-protective ventilation strategy can prospectively enhance clinical outcomes.
