Protocol for a multicentre retrospective observational cohort study in Denmark: association between the intraoperative peripheral perfusion index and postoperative morbidity and mortality in acute non-cardiac surgical patients

Marianne Agerskov; Anna Nicoline Wolfhagen Thusholdt; Jakob Højlund; Christian S Meyhoff; Henrik Sørensen; Sebastian Wiberg; Niels H Secher; Nicolai Bang Foss

doi:10.1136/bmjopen-2019-031249

Protocol for a multicentre retrospective observational cohort study in Denmark: association between the intraoperative peripheral perfusion index and postoperative morbidity and mortality in acute non-cardiac surgical patients

Marianne Agerskov^*, Anna Nicoline Wolfhagen Thusholdt, Jakob Højlund, Christian S Meyhoff, Henrik Sørensen, Sebastian Wiberg, Niels H Secher, Nicolai Bang Foss

^*Corresponding author for this work

Abstract

INTRODUCTION: Perioperative haemodynamic instability is associated with postoperative morbidity and mortality. Macrocirculatory parameters, such as arterial blood pressure and cardiac output are associated with poor outcome but may be uncoupled from the microcirculation during sepsis and hypovolaemia and may not be optimal resuscitation parameters. The peripheral perfusion index (PPI) is derived from the pulse oximetry signal. Reduced peripheral perfusion is associated with morbidity in critically ill patients and in patients following acute surgery. We hypothesise that a low intraoperative PPI is independently associated with postoperative complications and mortality. METHODS AND ANALYSIS: We plan to conduct a retrospective cohort study in approximately 2300 patients, who underwent acute non-cardiac surgery (1 November 2017 to 31 October 2018) at two Danish University Hospitals. Data will be collected from patient records including patient demographics, comorbidity and intraoperative haemodynamic values with PPI as the primary exposure variable, and postoperative complications and mortality within 30 and 90 days as outcome variables. We primarily assess association between PPI and outcome in multivariate regression models. Second, the predictive value of PPI for outcome, using area under the receiver operating characteristics curve is assessed. ETHICS AND DISSEMINATION: Data will be reported according to the Strengthening the Reporting of Observational Studies in Epidemiology and results published in a peer-reviewed journal. The study is approved by the regional research ethics committee, storage and management of data has been approved by the Regional Data Protection Agency, and access to medical records is approved by the hospital board of directors (ClinicalTrials.gov registration no: NCT03757442).

Original language	English
Article number	e031249
Journal	B M J Open
Volume	9
Issue number	11
Number of pages	6
ISSN	2044-6055
DOIs	https://doi.org/10.1136/bmjopen-2019-031249
Publication status	Published - 1 Nov 2019
Externally published	Yes

Keywords

Adult anaesthesia
Haemodynamics
Intensive and critical care
Peripheral perfusion

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Agerskov, M., Thusholdt, A. N. W., Højlund, J., Meyhoff, C. S., Sørensen, H., Wiberg, S., Secher, N. H., & Bang Foss, N. (2019). Protocol for a multicentre retrospective observational cohort study in Denmark: association between the intraoperative peripheral perfusion index and postoperative morbidity and mortality in acute non-cardiac surgical patients. B M J Open, 9(11), Article e031249. https://doi.org/10.1136/bmjopen-2019-031249

Protocol for a multicentre retrospective observational cohort study in Denmark: association between the intraoperative peripheral perfusion index and postoperative morbidity and mortality in acute non-cardiac surgical patients. / Agerskov, Marianne; Thusholdt, Anna Nicoline Wolfhagen; Højlund, Jakob et al.
In: B M J Open, Vol. 9, No. 11, e031249, 01.11.2019.

Research output: Contribution to journal › Journal article › Research › peer-review

Agerskov, M, Thusholdt, ANW, Højlund, J , Meyhoff, CS, Sørensen, H, Wiberg, S, Secher, NH & Bang Foss, N 2019, 'Protocol for a multicentre retrospective observational cohort study in Denmark: association between the intraoperative peripheral perfusion index and postoperative morbidity and mortality in acute non-cardiac surgical patients', B M J Open, vol. 9, no. 11, e031249. https://doi.org/10.1136/bmjopen-2019-031249

Agerskov M, Thusholdt ANW, Højlund J , Meyhoff CS, Sørensen H, Wiberg S et al. Protocol for a multicentre retrospective observational cohort study in Denmark: association between the intraoperative peripheral perfusion index and postoperative morbidity and mortality in acute non-cardiac surgical patients. B M J Open. 2019 Nov 1;9(11):e031249. doi: 10.1136/bmjopen-2019-031249

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abstract = "INTRODUCTION: Perioperative haemodynamic instability is associated with postoperative morbidity and mortality. Macrocirculatory parameters, such as arterial blood pressure and cardiac output are associated with poor outcome but may be uncoupled from the microcirculation during sepsis and hypovolaemia and may not be optimal resuscitation parameters. The peripheral perfusion index (PPI) is derived from the pulse oximetry signal. Reduced peripheral perfusion is associated with morbidity in critically ill patients and in patients following acute surgery. We hypothesise that a low intraoperative PPI is independently associated with postoperative complications and mortality. METHODS AND ANALYSIS: We plan to conduct a retrospective cohort study in approximately 2300 patients, who underwent acute non-cardiac surgery (1 November 2017 to 31 October 2018) at two Danish University Hospitals. Data will be collected from patient records including patient demographics, comorbidity and intraoperative haemodynamic values with PPI as the primary exposure variable, and postoperative complications and mortality within 30 and 90 days as outcome variables. We primarily assess association between PPI and outcome in multivariate regression models. Second, the predictive value of PPI for outcome, using area under the receiver operating characteristics curve is assessed. ETHICS AND DISSEMINATION: Data will be reported according to the Strengthening the Reporting of Observational Studies in Epidemiology and results published in a peer-reviewed journal. The study is approved by the regional research ethics committee, storage and management of data has been approved by the Regional Data Protection Agency, and access to medical records is approved by the hospital board of directors (ClinicalTrials.gov registration no: NCT03757442).",

keywords = "Adult anaesthesia, Haemodynamics, Intensive and critical care, Peripheral perfusion",

author = "Marianne Agerskov and Thusholdt, {Anna Nicoline Wolfhagen} and Jakob H{\o}jlund and Meyhoff, {Christian S} and Henrik S{\o}rensen and Sebastian Wiberg and Secher, {Niels H} and {Bang Foss}, Nicolai",

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T2 - association between the intraoperative peripheral perfusion index and postoperative morbidity and mortality in acute non-cardiac surgical patients

AU - Agerskov, Marianne

AU - Thusholdt, Anna Nicoline Wolfhagen

AU - Højlund, Jakob

AU - Meyhoff, Christian S

AU - Sørensen, Henrik

AU - Wiberg, Sebastian

AU - Secher, Niels H

AU - Bang Foss, Nicolai

N1 - (Ekstern)

PY - 2019/11/1

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N2 - INTRODUCTION: Perioperative haemodynamic instability is associated with postoperative morbidity and mortality. Macrocirculatory parameters, such as arterial blood pressure and cardiac output are associated with poor outcome but may be uncoupled from the microcirculation during sepsis and hypovolaemia and may not be optimal resuscitation parameters. The peripheral perfusion index (PPI) is derived from the pulse oximetry signal. Reduced peripheral perfusion is associated with morbidity in critically ill patients and in patients following acute surgery. We hypothesise that a low intraoperative PPI is independently associated with postoperative complications and mortality. METHODS AND ANALYSIS: We plan to conduct a retrospective cohort study in approximately 2300 patients, who underwent acute non-cardiac surgery (1 November 2017 to 31 October 2018) at two Danish University Hospitals. Data will be collected from patient records including patient demographics, comorbidity and intraoperative haemodynamic values with PPI as the primary exposure variable, and postoperative complications and mortality within 30 and 90 days as outcome variables. We primarily assess association between PPI and outcome in multivariate regression models. Second, the predictive value of PPI for outcome, using area under the receiver operating characteristics curve is assessed. ETHICS AND DISSEMINATION: Data will be reported according to the Strengthening the Reporting of Observational Studies in Epidemiology and results published in a peer-reviewed journal. The study is approved by the regional research ethics committee, storage and management of data has been approved by the Regional Data Protection Agency, and access to medical records is approved by the hospital board of directors (ClinicalTrials.gov registration no: NCT03757442).

AB - INTRODUCTION: Perioperative haemodynamic instability is associated with postoperative morbidity and mortality. Macrocirculatory parameters, such as arterial blood pressure and cardiac output are associated with poor outcome but may be uncoupled from the microcirculation during sepsis and hypovolaemia and may not be optimal resuscitation parameters. The peripheral perfusion index (PPI) is derived from the pulse oximetry signal. Reduced peripheral perfusion is associated with morbidity in critically ill patients and in patients following acute surgery. We hypothesise that a low intraoperative PPI is independently associated with postoperative complications and mortality. METHODS AND ANALYSIS: We plan to conduct a retrospective cohort study in approximately 2300 patients, who underwent acute non-cardiac surgery (1 November 2017 to 31 October 2018) at two Danish University Hospitals. Data will be collected from patient records including patient demographics, comorbidity and intraoperative haemodynamic values with PPI as the primary exposure variable, and postoperative complications and mortality within 30 and 90 days as outcome variables. We primarily assess association between PPI and outcome in multivariate regression models. Second, the predictive value of PPI for outcome, using area under the receiver operating characteristics curve is assessed. ETHICS AND DISSEMINATION: Data will be reported according to the Strengthening the Reporting of Observational Studies in Epidemiology and results published in a peer-reviewed journal. The study is approved by the regional research ethics committee, storage and management of data has been approved by the Regional Data Protection Agency, and access to medical records is approved by the hospital board of directors (ClinicalTrials.gov registration no: NCT03757442).

KW - Adult anaesthesia

KW - Haemodynamics

KW - Intensive and critical care

KW - Peripheral perfusion

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DO - 10.1136/bmjopen-2019-031249

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