Duration of Ventilation, Not Surgical Method, Linked to Postoperative Pulmonary Complications: JAMA
Researchers have found in a new study that although robot-assisted procedures had higher unadjusted rates of postoperative pulmonary complications (PPCs) and required longer, more intense mechanical ventilation than conventional laparoscopy, only the duration of ventilation, not its intensity or surgical approach, was independently associated with postoperative pulmonary complications. The study was published in JAMA Surgery by Simon C. and colleagues.
This new cohort study analyzed 2738 adults in the LapRAS database, combining prospective data collected from 163 centers in 31 countries between January 2013 and March 2019. It attempted to establish whether the type of surgery, duration of mechanical ventilation, or the intensity of ventilation is more closely associated with the risk of PPC.
This cohort study pooled together individual patient data from two global prospective studies, LAS VEGAS and AVATaR, to evaluate PPCs within the first 5 days after surgery. Patients were adults undergoing general anesthesia with mechanical ventilation for either CLS or RAS. The analysis included patient, procedural, and anesthesia-related factors.
The main exposure variables were:
• Surgical approach (CLS versus RAS),
• Duration of intraoperative ventilation,
• Intensity of mechanical ventilation, quantified using the 4DP + RR estimator.
The independent associations were assessed by mixed-effects logistic regression models. Sensitivity analyses included mediation and matched cohorts, and a post hoc analysis explored the differential effect of ventilation intensity in shorter surgeries.
Results
• In all, 2738 patients were included, with a median age of 56 years, and 53.1% of them were female.
• The incidence of PPCs in patients who underwent RAS was 19.0% (172/903), compared with 9.5% in those who underwent CLS (174/1835) (P < 0.001).
The ventilation duration was longer in RAS:
• Median 219 minutes (IQR 180–270) vs 95 minutes (IQR 68–145) in CLS (P < 0.001).
• Ventilation intensity was higher in RAS, with a median of 84 (IQR 69–100) versus 72 (IQR 60–87) in CLS (P < 0.001).
Although the rates of PPC were higher and the ventilation parameters more aggressive in RAS, only the duration of ventilation was independently associated with PPCs:
• aOR 1.49 (95% CI 1.33–1.66; P < 0.001).
• A post hoc analysis indicated the effect of ventilation intensity may have been greater in the shorter procedures, implying a time-dependent interaction.
In this multinational cohort study, robotic-assisted surgery was associated with a higher incidence of postoperative pulmonary complications, although only the duration of intraoperative mechanical ventilation and not surgical approach or ventilation intensity predicted these complications independently.
Reference:
Serafini SC, Hemmes SNT, Queiroz VNF, et al. Postoperative Pulmonary Complications in Conventional Laparoscopic vs Robot-Assisted Abdominal Surgery. JAMA Surg. 2025;160(11):1222–1231. doi:10.1001/jamasurg.2025.3581
