Advertisement

Journal of Anesthesia

, Volume 33, Issue 1, pp 159–162 | Cite as

Utilization of arterial pulse waveform analysis during non-cardiac surgery in Japan: a retrospective observational study using a nationwide claims database

  • Chikashi Takeda
  • Masato Takeuchi
  • Toshiyuki Mizota
  • Hiroshi Yonekura
  • Isao Nahara
  • Aki Kuwauchi
  • Woo Jin Joo
  • Yohei Kawasaki
  • Koji KawakamiEmail author
Short Communication

Abstract

Arterial pulse waveform analysis (APWA) is used for cardiac output monitoring. However, data on the frequency of and patient characteristics for specialized pressure transducer for APWA (S-APWA) use are lacking. We retrospectively identified 175,201 patients aged 18 years or older, who underwent non-cardiac surgery under general anesthesia with an arterial catheter from January 1, 2014, to December 31, 2016. We extracted data on patient demographics, comorbidities, surgical and anesthesia characteristics, and hospital characteristics. Among the full study cohort, 24,605 (14.0%) patients were monitored using S-APWA. Further, the use of S-APWA was higher in patients undergoing high-risk surgery than in those undergoing low-risk surgery [high vs low: adjusted odds ratio (aOR) 1.95; 95% confidence interval (CI) 1.76–2.15, moderate vs low: aOR 1.11; 95% CI 1.01–1.22] and those with more comorbidities than in those with less comorbidities (high vs low: aOR 1.49; 95% CI 1.42–1.56, moderate vs low: aOR 1.25; 95% CI 1.20–1.31). S-APWA use was significantly associated with both surgery risk and patients’ comorbidities. In conclusion, our study may provide a benchmark for future studies related to the appropriate use of S-APWA.

Keywords

Arterial pulse waveform analysis Goal-directed therapy FloTrac/Vigileo system Non-cardiac surgery Claims database 

Notes

Acknowledgements

We acknowledge Professor Kazuhiko Fukuda, M.D., Ph.D. (affiliated with the Department of Anesthesia, Kyoto University Hospital, Kyoto, Japan) for his valuable comments on the study. We also thank Mr. Masaki Nakamura and staff at Medical Data Vision, Co, Ltd. (Tokyo, Japan) for data preparation assistance for free. We also thank Editage (http://www.editage.jp) for English language editing.

Funding

This study has received departmental funds from the Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University.

Supplementary material

540_2018_2609_MOESM1_ESM.tiff (33.2 mb)
Supplemental Figure 1. Study flow diagram. The data represent per procedure and included all procedures of patients who underwent multiple eligibility procedures during the study period (TIFF 33972 KB)
540_2018_2609_MOESM2_ESM.docx (26 kb)
Supplemental Table 1. Patient and facility characteristics associated with S-APWA use. All data are described as number (%), except for age and BMI. We also showed the proportion of S-APWA use at each category. Abbreviations: BMI, body mass index; SD, standard deviation; S-APWA, specialized pressure transducer for arterial pulse waveform analysis (DOCX 26 KB)

References

  1. 1.
    Doherty M, Buggy DJ. Intraoperative fluids: how much is too much? Br J Anaesth. 2012;109:69–79.CrossRefGoogle Scholar
  2. 2.
    Bellamy MC. Wet, dry or something else? Br J Anaesth. 2006;97(6):755–7.CrossRefGoogle Scholar
  3. 3.
    Joshi GP. Intraoperative fluid restriction improves outcome after major elective gastrointestinal surgery. Anesth Analg. 2005;101:601–5.CrossRefGoogle Scholar
  4. 4.
    Benes J, Giglio M, Brienza N, Michard F. The effects of goal-directed fluid therapy based on dynamic parameters on post-surgical outcome: a meta-analysis of randomized controlled trials. Crit Care. 2014;18:584.CrossRefGoogle Scholar
  5. 5.
    Manecke GR. Edwards FloTrac sensor and Vigileo monitor: easy, accurate, reliable cardiac output assessment using the arterial pulse wave. Expert Rev Med Devices. 2005;2:523–7.CrossRefGoogle Scholar
  6. 6.
    Benes J, Chytra I, Altmann P, Hluchy M, Kasal E, Svitak R, Pradl R, Stepan M. Intraoperative fluid optimization using stroke volume variation in high risk surgical patients: results of prospective randomized study. Crit Care. 2010;14:R118.CrossRefGoogle Scholar
  7. 7.
    Salzwedel C, Puig J, Carstens A, Bein B, Molnar Z, Kiss K, Hussain A, Belda J, Kirov MY, Sakka SG, Reuter DA. Perioperative goal-directed hemodynamic therapy based on radial arterial pulse pressure variation and continuous cardiac index trending reduces postoperative complications after major abdominal surgery: a multi-center, prospective, randomized study. Crit Care. 2013;17:R191.CrossRefGoogle Scholar
  8. 8.
    Suehiro K, Tanaka K, Mukai A, Joosten A, Desebbe O, Alexander B, Canesson M, Nishikawa K. Hemodynamic monitoring and management in high-risk surgery: a survey among Japanese anesthesiologists. J Anesth. 2016;30:526–9.CrossRefGoogle Scholar
  9. 9.
    Cannesson M, Pestel G, Ricks C, Hoeft A, Perel A. Hemodynamic monitoring and management in patients undergoing high risk surgery: a survey among North American and European anesthesiologists. Crit Care. 2011;15:R197.CrossRefGoogle Scholar
  10. 10.
    Minoura T, Takeuchi M, Morita T, Kawakami K. Practice patterns of medications for patients with malignant bowel obstruction using a nationwide claims database and the association between treatment outcomes and concomitant use of h2-blockers/proton pump inhibitors and corticosteroids with octreotide. J Pain Symptom Manag. 2018;55:413–19.e2.CrossRefGoogle Scholar
  11. 11.
    Miyamoto Y, Shinzawa M, Tanaka S, Tanaka-Mizuno S, Kawakami K. Perioperative steroid use for tonsillectomy and its association with reoperation for posttonsillectomy hemorrhage: a retrospective cohort study. Anesth Analg. 2018;126:806–14.CrossRefGoogle Scholar
  12. 12.
    Quan H, Sundararajan V, Halfon P, Fong A, Burnand B, Luthi J, Saunders LD, Beck CA, Feasby TE, Ghali WA. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care. 2005;43:1130–9.CrossRefGoogle Scholar
  13. 13.
    Kristensen SD, Knuuti J, Saraste A, Anker S, Botker HE, Hert SD, Ford I, Gonzalez-Juanatey JR, Gorenek B, Heyndrickx GR, Hoeft A, Huber K, Iung B, Kjeldsen KP, Longrois D, Lüscher TF, Pierard L, Pocock S, Price S, Roffi M, Sirnes PA, Sousa-Uva M, Voudris V, Funck-Brentano C, Authors/Task Force Members. 2014 ESC/ESA guidelines on non-cardiac surgery: cardiovascular assessment and management: the Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur Heart J. 2014;35:2383–431.CrossRefGoogle Scholar
  14. 14.
    Bayindir EE. Hospital ownership type and treatment choices. J Health Econ. 2012;31:359–70.CrossRefGoogle Scholar

Copyright information

© Japanese Society of Anesthesiologists 2019

Authors and Affiliations

  • Chikashi Takeda
    • 1
    • 2
  • Masato Takeuchi
    • 1
  • Toshiyuki Mizota
    • 2
  • Hiroshi Yonekura
    • 1
  • Isao Nahara
    • 1
  • Aki Kuwauchi
    • 1
  • Woo Jin Joo
    • 1
  • Yohei Kawasaki
    • 1
    • 3
  • Koji Kawakami
    • 1
    Email author
  1. 1.Department of Pharmacoepidemiology, Graduate School of Medicine and Public HealthKyoto UniversityKyotoJapan
  2. 2.Department of AnesthesiaKyoto University HospitalKyotoJapan
  3. 3.Biostatistics Section, Clinical Research CenterChiba University HospitalChibaJapan

Personalised recommendations