Determinants and Practice Variability of Oxygen Administration during Surgery in the United States: A Retrospective Cohort Study

Author:

Billings Frederic T.1,McIlroy David R.2,Shotwell Matthew S.3,Lopez Marcos G.4ORCID,Vaughn Michelle T.5,Morse Jennifer L.6,Hennessey Cassandra J.7,Wanderer Jonathan P.8ORCID,Semler Matthew W.9ORCID,Rice Todd W.10ORCID,Wunsch Hannah11,Kheterpal Sachin12

Affiliation:

1. 1Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee.

2. 2Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee.

3. 3Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee.

4. 4Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee.

5. 5Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan.

6. 6Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee.

7. 7Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee.

8. 8Departments of Anesthesiology and Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee.

9. 9Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.

10. 10Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.

11. 11Department of Anesthesiology, New York–Presbyterian Hospital/Weill Cornell Medicine, New York, New York.

12. 12Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan.

Abstract

Background The best approaches to supplemental oxygen administration during surgery remain unclear, which may contribute to variation in practice. This study aimed to assess determinants of oxygen administration and its variability during surgery. Methods Using multivariable linear mixed-effects regression, the study measured the associations between intraoperative fraction of inspired oxygen and patient, procedure, medical center, anesthesiologist, and in-room anesthesia provider factors in surgical cases of 120 min or longer in adult patients who received general anesthesia with tracheal intubation and were admitted to the hospital after surgery between January 2016 and January 2019 at 42 medical centers across the United States participating in the Multicenter Perioperative Outcomes Group data registry. Results The sample included 367,841 cases (median [25th, 75th] age, 59 [47, 69] yr; 51.1% women; 26.1% treated with nitrous oxide) managed by 3,836 anesthesiologists and 15,381 in-room anesthesia providers. Median (25th, 75th) fraction of inspired oxygen was 0.55 (0.48, 0.61), with 6.9% of cases less than 0.40 and 8.7% greater than 0.90. Numerous patient and procedure factors were statistically associated with increased inspired oxygen, notably advanced American Society of Anesthesiologists classification, heart disease, emergency surgery, and cardiac surgery, but most factors had little clinical significance (less than 1% inspired oxygen change). Overall, patient factors only explained 3.5% (95% CI, 3.5 to 3.5%) of the variability in oxygen administration, and procedure factors 4.4% (95% CI, 4.2 to 4.6%). Anesthesiologist explained 7.7% (95% CI, 7.2 to 8.2%) of the variability in oxygen administration, in-room anesthesia provider 8.1% (95% CI, 7.8 to 8.4%), medical center 23.3% (95% CI, 22.4 to 24.2%), and 53.0% (95% CI, 52.4 to 53.6%) was unexplained. Conclusions Among adults undergoing surgery with anesthesia and tracheal intubation, supplemental oxygen administration was variable and appeared arbitrary. Most patient and procedure factors had statistical but minor clinical associations with oxygen administration. Medical center and anesthesia provider explained significantly more variability in oxygen administration than patient or procedure factors. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Publisher

Ovid Technologies (Wolters Kluwer Health)

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