| Title: |
General anaesthesia versus monitored anaesthesia care and postoperative outcome in patients with elevated right ventricular systolic pressure undergoing low-risk surgical procedures: a retrospective single-centre cohort study |
| Authors: |
Maziar M. Nourian; Amelie Delaporte; Theodora Wingert; Nancy M. Boulos; Tristan Grogan; Emily Methangkool; Jacques Neelankavil; Louis A. Saddic; Maxime Cannesson; Olaf Mercier; Soban Umar; Marc Humbert; Laurent Savale; Alexandre Joosten |
| Source: |
BJA Open, Vol 17, Iss , Pp 100529- (2026) |
| Publisher Information: |
Elsevier |
| Publication Year: |
2026 |
| Collection: |
Directory of Open Access Journals: DOAJ Articles |
| Subject Terms: |
anaesthesia; general; conscious sedation; postoperative complications; pulmonary hypertension; right ventricular function; Anesthesiology; RD78.3-87.3 |
| Description: |
Background: Pulmonary hypertension, often indicated before surgery by elevated right ventricular systolic pressure (RVSP) on echocardiography, is associated with increased perioperative risk. For low-risk procedures in which either general anaesthesia or monitored anaesthesia care may be selected, comparative data on postoperative outcomes are limited. Methods: We conducted a single-centre retrospective observational cohort study of 4962 adults with RVSP >50 mm Hg who underwent low-risk procedures. Eligible procedures included endoscopy, bronchoscopy, catheterisation laboratory interventions, and peripheral surgeries. The primary outcome was a composite of acute kidney injury, acute myocardial injury, or 30-day mortality. Analyses used multivariable logistic regression and inverse probability of treatment weighting based on preoperative covariates. Intraoperative variables were evaluated as potential mediators in sensitivity analyses. Results: Of the 4962 patients, 2473 received general anaesthesia and 2489 received monitored anaesthesia care. In preoperative-adjusted models, general anaesthesia was associated with higher odds of major complications (odds ratio, 1.24; 95% confidence interval [95% CI], 1.02–1.51; P=0.030). A doubly robust inverse probability weighted model produced similar results (odds ratio, 1.36; 95% CI, 1.08–1.70; P=0.0076), with estimated risks of 39.7% vs 32.7%. Incorporating intraoperative factors such as anaesthesia duration, vasopressor use, and fluid balance attenuated the association (odds ratio, 1.00; 95% CI, 0.81–1.23). No significant interactions were observed by emergency status or preoperative pulmonary hypertension-targeted therapy. Conclusions: After adjustment for preoperative risk and evaluating intraoperative mediators, we found no evidence of a statistically significant difference in major postoperative complications between general anaesthesia and monitored anaesthesia care in adults with elevated RVSP undergoing low-risk procedures. |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| ISBN: |
978-2-7726-0962-9; 2-7726-0962-6 |
| Relation: |
http://www.sciencedirect.com/science/article/pii/S2772609626000031; https://doaj.org/toc/2772-6096; https://doaj.org/article/882c06533b384c99a19c30c83c3e5973 |
| DOI: |
10.1016/j.bjao.2026.100529 |
| Availability: |
https://doi.org/10.1016/j.bjao.2026.100529; https://doaj.org/article/882c06533b384c99a19c30c83c3e5973 |
| Accession Number: |
edsbas.342C3E5 |
| Database: |
BASE |