13 Nov 06
Multicenter study on peri-postoperative central venous oxygen saturation in high-risk surgical patients
By SM Jakob and The Collaborative study group on peri-operative ScvO2 monitoring
Low central venous oxygen saturation (ScvO2) has been associated with increased risk of postoperative complications in high-risk surgery. Whether this association is center-specific or more generalizable is not known. The aim of this study was to assess the association between peri- and postoperative ScvO2 and outcome in high-risk surgical patients in a multi-center setting.
Methods
Three large European university hospitals (two in Finland, one in Switzerland) participated. In 60 patients with intra-abdominal surgery lasting >90 minutes, the presence of >/=2 Shoemaker criteria, and American Society of Anesthesiologists (ASA) class >2, ScvO2 was determined preoperatively and at 2-hour intervals during the operation until 12 hours postoperatively. Hospital length of stay (LOS), mortality and predefined postoperative complications were recorded.
Results
The age of the patients was 72 +/-10 years (mean +/-SD), and simplified acute physiology score (SAPS II) was 32 +/-12. Overall LOS was 10.5 (8-14) days, and 28-day hospital mortality was 10.0%. Preoperative ScvO2 decreased from 77 +/-10% to 70 +/-11% (p<0.001) immediately after surgery and remained unchanged 12 hours later. A total of 67 postoperative complications were recorded in 32 patients. After multivariate analysis, mean ScvO2 value (odds ratio [OR] 1.23 [95% confidence interval 1.01 to 1.50]; p = 0.037), length of hospital stay (OR 0.75 [0.59 to 0.94]; p = 0.012) and SAPS II (OR 0.90 [0.82 to 0.99]; p = 0.029) were independently associated with postoperative complications. The optimal value of mean ScvO2 to discriminate between patients who did or did not develop complications was 73% (sensitivity 72%, specificity 61%).
Conclusions
Low central venous oxygen saturation perioperatively is related to increased risk of postoperative complications in high-risk surgery. This warrants trials with goal-directed therapy using ScvO2 as a target in high-risk surgery patients.