Association of anesthetic technique with mortality and morbidity in patients undergoing surgery with one-lung ventilation under general anaesthesia.

BACKGROUND

General anesthesia is the standard requirement for surgical procedures necessitating one-lung ventilation (OLV). The choice of anesthesia is a critical consideration, but which anesthetic modality is the most advantageous remains controversial. We evaluated the association of propofol-based total intravenous anesthesia (TIVA) and inhalation anesthesia (INH) during OLV with mortality and morbidity.

METHODS

This population-based cohort study included adult patients who underwent OLV for surgery between January 1 and December 31, 2021, in South Korea. The INH and TIVA groups underwent 1:1 propensity score matching to balance patient characteristics before group comparisons. The endpoints were 90-day mortality, 1-year all-cause mortality, and postoperative complications.

RESULTS

The final study included 22,925 patients who underwent surgery with OLV under general anaesthesia. The INH and TIVA groups included 16,114 and 6,811 patients, respectively. After propensity score matching, data of 6,811 patients per group were compared. Logistic regression analysis revealed no statistically significant difference in the 90-day mortality rate between the two groups [odds ratio (OR) 1.08; 95% confidence interval (CI): 0.91-1.28; P=0.37]. Moreover, the 1-year all-cause mortality rate did not differ significantly between the groups in Cox regression analysis (hazard ratio 1.07; 95% CI: 0.96-1.19; P=0.21). However, TIVA was associated with higher rates of sepsis, acute coronary events, acute kidney injury, and heart failure, whereas it was associated with lower rates of postoperative pneumonia, pulmonary embolism, and wound infection compared to the INH group.

CONCLUSIONS

The type of anesthesia used during surgery with OLV was not significantly associated with 90-day or 1-year all-cause mortality. However, the choice of anesthetic agent appears to influence specific postoperative complication profiles, suggesting the need for an individualized approach based on patient-specific risk factors.