Objective To examine whether supraphysiological oxygen administration during surgery is associated with lower or higher postoperative kidney, heart, and lung injury. Design Observational cohort study. Setting 42 medical centers across the United States participating in the Multicenter Perioperative Outcomes Group data registry. Participants Adult patients undergoing surgical procedures ≥120 minutes’ duration with general anesthesia and endotracheal intubation who were admitted to hospital after surgery between January 2016 and November 2018. Intervention Supraphysiological oxygen administration, defined as the area under the curve of the fraction of inspired oxygen above air (21%) during minutes when the hemoglobin oxygen saturation was greater than 92%. Main outcomes Primary endpoints were acute kidney injury defined using Kidney Disease Improving Global Outcomes criteria, myocardial injury defined as serum troponin >0.04 ng/mL within 72 hours of surgery, and lung injury defined using international classification of diseases hospital discharge diagnosis codes. Results The cohort comprised 350 647 patients with median age 59 years (interquartile range 46-69 years), 180 546 women (51.5%), and median duration of surgery 205 minutes (interquartile range 158-279 minutes). Acute kidney injury was diagnosed in 19 207 of 297 554 patients (6.5%), myocardial injury in 8972 of 320 527 (2.8%), and lung injury in 13 789 of 312 161 (4.4%). The median fraction of inspired oxygen was 54.0% (interquartile range 47.5%-60.0%), and the area under the curve of supraphysiological inspired oxygen was 7951% min (5870-11 107% min), equivalent to an 80% fraction of inspired oxygen throughout a 135 minute procedure, for example. After accounting for baseline covariates and other potential confounding variables, increased oxygen exposure was associated with a higher risk of acute kidney injury, myocardial injury, and lung injury. Patients at the 75th centile for the area under the curve of the fraction of inspired oxygen had 26% greater odds of acute kidney injury (95% confidence interval 22% to 30%), 12% greater odds of myocardial injury (7% to 17%), and 14% greater odds of lung injury (12% to 16%) compared with patients at the 25th centile. Sensitivity analyses evaluating alternative definitions of the exposure, restricting the cohort, and conducting an instrumental variable analysis confirmed these observations. Conclusions Increased supraphysiological oxygen administration during surgery was associated with a higher incidence of kidney, myocardial, and lung injury. Residual confounding of these associations cannot be excluded. Trial registration Open Science Framework [osf.io/cfd2m][1] Cohort data may be obtained upon reasonable request. Analytical code used for the present analysis can be made available with approval from the senior author of the manuscript. Individual patient data will not be made publicly available. [1]: http://osf.io/cfd2m

中文翻译：

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手术期间的氧气管理和术后器官损伤：观察性队列研究

目的 研究手术期间超生理供氧是否与术后肾脏、心脏和肺损伤的降低或升高有关。设计观察性队列研究。在美国设置 42 个医疗中心参与多中心围手术期结果组数据登记。参与者 在 2016 年 1 月至 2018 年 11 月期间接受外科手术持续时间≥120 分钟并接受全身麻醉和气管插管的成年患者。在血红蛋白氧饱和度大于 92% 的几分钟内空气 (21%)。主要结果 主要终点是使用肾脏疾病改善全球结果标准定义的急性肾损伤、定义为手术后 72 小时内血清肌钙蛋白 >0.04 ng/mL 的心肌损伤，以及使用国际疾病分类出院诊断代码定义的肺损伤。结果 该队列包括 350 647 名患者，中位年龄 59 岁（四分位间距 46-69 岁），180 546 名女性 (51.5%)，中位手术持续时间 205 分钟（四分位间距 158-279 分钟）。297 554 例患者中有 19 207 例诊断为急性肾损伤（6.5%），320 527 例患者中有 8972 例诊断为心肌损伤（2.8%），312 161 例患者中有 13 789 例诊断为肺损伤（4.4%）。吸入氧的中位数分数为 54.0%（四分位数范围 47.5%-60.0%），例如，超生理吸入氧气曲线下的面积为 7951% 分钟（5870-11 107% 分钟），相当于整个 135 分钟程序中吸入氧气的 80%。在考虑基线协变量和其他潜在混杂变量后，氧暴露增加与急性肾损伤、心肌损伤和肺损伤的风险增加有关。吸入氧分数曲线下面积处于第 75 个百分位的患者发生急性肾损伤的几率增加 26%（95% 置信区间 22% 至 30%），心肌损伤几率增加 12%（7% 至 17 %)，与第 25 个百分位数的患者相比，肺损伤的几率增加 14%（12% 至 16%）。敏感性分析评估暴露的替代定义，限制队列，并进行工具变量分析证实了这些观察结果。结论 手术期间增加超生理供氧与更高的肾脏、心肌和肺损伤发生率相关。不能排除这些关联的残余混杂。试用注册开放科学框架 [osf.io/cfd2m][1] 队列数据可根据合理要求获得。用于本分析的分析代码可以在手稿的高级作者批准后提供。个别患者数据不会公开。[1]: http://osf.io/cfd2m 不能排除这些关联的残余混杂。试用注册开放科学框架 [osf.io/cfd2m][1] 队列数据可根据合理要求获得。用于本分析的分析代码可以在手稿的高级作者批准后提供。个别患者数据不会公开。[1]: http://osf.io/cfd2m 不能排除这些关联的残余混杂。试用注册开放科学框架 [osf.io/cfd2m][1] 队列数据可根据合理要求获得。用于本分析的分析代码可以在手稿的高级作者批准后提供。个别患者数据不会公开。[1]: http://osf.io/cfd2m