Effect of a Perioperative Opioid Free Anaesthesia-Analgesia (OFA-A) Strategy on Surgical Stress Response and Immunomodulation in Elective VATS Lobectomy for NSCLC Lung Cancer: A Prospective Randomized Study
Overview
- Phase
- Phase 4
- Intervention
- Opioid-Based Anesthesia-Analgesia Strategy
- Conditions
- Systemic Inflammatory Response Syndrome
- Sponsor
- University of Crete
- Enrollment
- 70
- Locations
- 1
- Primary Endpoint
- Advanced Lung Cancer Inflammation Index (ALI)
- Status
- Recruiting
- Last Updated
- 4 years ago
Overview
Brief Summary
Lobectomy is a major, high-risk surgical procedure that in addition to one-lung ventilation (OLV) exerts a potent surgical stress response. An overwhelming immune cell recruitment may lead to excessive tissue damage, peripheral organ injury and immunoparesis. The effect of anesthesia on the immune system is modest, compared to the effects induced by major surgery. However, to an immunocompromised patient, due to cancer and/or other comorbidities, the immunosuppressive effects of anesthesia may increase the incidence of post-operative infections, morbidity, and mortality. Exogenous opioids have been correlated with immunosuppression, opioid-induced hyperalgesia, and respiratory depression, with deleterious outcomes. An Opioid-Free Anaesthesia-Analgesia (OFA-A) strategy is based on the administration of a variety of anaesthetic/analgesic and other pharmacological agents with different mechanisms of action, including immunomodulating and anti-inflammatory effects. Our basic hypothesis is that the implementation of a perioperative multimodal OFA-A strategy, will lead to an attenuated surgical stress response and attenuated immunosuppression, compared to a conventional Opioid-Based Anaesthesia-Analgesia (OBA-A) strategy. The aforementioned effects, are presumed to be associated with equal or improved analgesia and decreased incidence of postoperative infections compared to a perioperative OBA-A technique.
Detailed Description
Surgical manipulation and one lung ventilation (OLV) exert different and synergic effects to generate an inflammatory response during lung resection surgery. Surgery, such as lobectomies, often leads to severe immunosuppression that in turn can lead to infectious complications and sepsis. Both anesthesia-related and surgery-related perioperative measures may modulate the patient's immune response and lead to the activation of different components of the immune system. Anesthesia-induced activation, in particular of the adaptive immune system, may also induce persistent, postoperative immunosuppression. An overwhelming immune cell recruitment may lead to excessive tissue damage, peripheral organ injury and immunoparesis. Opioid analgesia remains the corner stone of acute pain management in perioperative analgesic regimes. Opioid receptors are not only expressed in the central nervous system to regulate pain perception but also occur on immune and tumour cells. Exogenous opioid administration has been correlated with immunosuppression, opioid-induced hyperalgesia, and respiratory depression, with deleterious outcomes. An Opioid-Free Anaesthesia-Analgesia (OFA-A) strategy is based on the administration of a variety of anaesthetic/analgesic and other pharmacological agents with different mechanisms of action, including immunomodulating and anti-inflammatory effects where at least one factor causes inhibition of central sensitization and at least another factor inhibits the peripheral sensitization of the nervous system, as a response to painful surgical stimuli. This combination of factors has to have a synergistic or additive effect so that best analgesic effects can be achieved with the lowest possible dosage. Our basic hypothesis is that a perioperative OFA-A strategy on cancer patients undergoing VATS lung surgery for tumour resection will be accompanied by abolished or attenuated immunosuppression. The additional potential clinical implication of a perioperative OFA-A strategy is the avoidance of the onco-proliferative side effects of both exogenous and endogenous opioids, released by cytokine-mediated immune cell activation. Inflammatory response inhibition is expected to reduce the possibility of acute and chronic post-operative pain developement, compared to a perioperative Opioid-Based Anaesthesia- Analgesia (OBA-A) technique. Additionally, the aforementioned inflammatory response inhibition is expected to lead to an overall reduction of overall postoperative pulmonary complications.
Investigators
Periklis Vasilos
Principal Investigator
University of Crete
Eligibility Criteria
Inclusion Criteria
- •patients undergoing elective VATS lobectomy
- •early stage NSCLC (up to T3N1M0)
Exclusion Criteria
- •Immunocompromised patients
- •previous lung surgery
- •preoperative corticosteroid or immunosuppressive drug use
- •uncontrolled Diabetes Mellitus
- •cardiac failure (NYHA 3 and 4)
- •preoperative infection (CRP \>5mg/ml, WBC \>10x10\^9/L)
- •preoperative anemia (Hb\<12g/dl)
- •chronic inflammatory diseases
- •inflammatory bowel disease
- •Group-specific exclusion criteria:
Arms & Interventions
Opioid-Based Anaesthesia Analgesia
Premedication: IM Midazolam 0.05-0.07mg/kg. Anesthesia induction: Midazolam 0.03mg/kg, Propofol 2-3mg/kg, Fentanyl 1-2mcg/kg and Cisatracurium 0.2mg/kg or alternatively Rocuronium 0.6-1.2mg/ kg. Anesthesia maintenance: Desflurane set at approximately 1 MAC, Morphine 0.1-0.12mg/kg, Fentanyl 1-2mcg/kg during induction and 50-100mcg prn, Paracetamol 1g +/- Dexketoprofen trometamol 50mg, along with Ondansetron 4mg or Droperidol 0.625mg. Wound infiltration: Ropivacaine 75-150mg. Surgical ward: PCA pump with Morphine for the first 3 postoperative days. Additional postoperative analgesia: Paracetamol 1g 1x3 +/- Dexketoprofen trometamol 50mg 1x2. Rescue therapy only: Tramadol 50-100mg.
Intervention: Opioid-Based Anesthesia-Analgesia Strategy
Opioid-Free Anesthesia Analgesia
Premedication: Pregabalin 150mg 1x2, IM Midazolam 0.05-0.07mg/kg. Anesthesia induction: Midazolam 0.03mg/kg, Dexmedetomidine 0.5-1mcg/kg, Lidocaine 1mg/kg, Propofol 2-3mg/kg, Ketamine 1-1.5mg/kg, Hyoscine 10mg, Cisatracurium 0.2mg/ kg or alternatively Rocuronium 0.6-1.2mg/kg, Magnesium sulphate 2.5-5g and Dexamethasone 8-16mg. Anesthesia maintenance: Desflurane set at \~1 MAC, Dexmedetomidine 0.5-1.2mcg/kg/h, Lidocaine 0.5-1mg/kg/h, Ketamine 0.3-0.5mg/kg prn, Paracetamol 1g +/- Dexketoprofen trometamol 50mg, and Ondansetron 4mg or Droperidol 0.625mg. Wound infiltration: Ropivacaine 75-150mg. Surgical ward: PCA pump with Ketamine, Lidocaine, Clonidine, Droperidol and Midazolam for the first 3 postoperative days. Additionally, Pregabalin 50mg per os 1x1 and 25mg 1x1, Paracetamol 1g 1x3 +/- Dexketoprofen trometamol 50mg 1x2. Rescue therapy only: Tramadol 50-100mg.
Intervention: Opioid-free Anesthesia-Analgesia Strategy
Outcomes
Primary Outcomes
Advanced Lung Cancer Inflammation Index (ALI)
Time Frame: Preoperatively
Advanced Lung Cancer Inflammation Index (ALI) is a prognostic index that predicts patients' recurrence-free survival and overall survival. ALI is calculated as (BMI x Alb / NLR) where BMI = body mass index, Alb = serum albumin, NLR (neutrophil lymphocyte ratio, a marker of systemic inflammation). Higher ALI scores have been correlated with worse outcome.
Surgical Stress Response - IL-10 - 24 hours after the end of surgery
Time Frame: 24 hours after the end of surgery (end of placement of last suture/ surgical clip on patient)
Inflammatory response and stress response as quantified by IL-10 serum levels. Blood sample collection will take place in both study groups
Surgical Stress Response - TNF-a - preoperatively
Time Frame: Preoperatively (as a baseline)
Inflammatory response and stress response as quantified by TNF-a serum levels. Blood sample collection will take place in both study groups
Surgical Stress Response - CRP - preoperatively
Time Frame: Preoperatively (as a baseline)
Inflammatory response and stress response as quantified by CRP serum levels. Blood sample collection will take place in both study groups
Systemic Immune Inflammation Index (SII)
Time Frame: Preoperatively
Systemic Immune Inflammation Index (SII) is a prognostic index that predicts patients' overall survival. SII is calculated as follows: SII = platelet count × neutrophil/lymphocyte count. Higher SII scores have been correlated with worse outcome.
Prognostic Nutritional Index (PNI)
Time Frame: Preoperatively
Prognostic Nutritional Index (PNI) is a prognostic index that predicts patients' overall survival. PNI is calculated as follows: PNI = 10 × serum albumin value (g/dL) + 0.005 × total lymphocyte count (per mm3) in the peripheral blood. Higher PNI scores have been correlated with worse outcome.
Surgical Stress Response - IL-6 - preoperatively
Time Frame: Preoperatively (as a baseline)
Inflammatory response and stress response as quantified by IL-6 serum levels. Blood sample collection will take place in both study groups
Surgical Stress Response - IL-6 - end of surgery
Time Frame: End of surgery (end of placement of last suture/ surgical clip on patient)
Inflammatory response and stress response as quantified by IL-6 serum levels. Blood sample collection will take place in both study groups
Surgical Stress Response - IL-6 - 24 hours after the end of surgery
Time Frame: 24 hours after the end of surgery (end of placement of last suture/ surgical clip on patient)
Inflammatory response and stress response as quantified by IL-6 serum levels. Blood sample collection will take place in both study groups
Surgical Stress Response - IL-8 - preoperatively
Time Frame: Preoperatively (as a baseline)
Inflammatory response and stress response as quantified by IL-8 serum levels. Blood sample collection will take place in both study groups
Surgical Stress Response - IL-8 - end of surgery
Time Frame: End of surgery (end of placement of last suture/ surgical clip on patient)
Inflammatory response and stress response as quantified by IL-8 serum levels. Blood sample collection will take place in both study groups
Surgical Stress Response - IL-8 - 24 hours after the end of surgery
Time Frame: 24 hours after the end of surgery (end of placement of last suture/ surgical clip on patient)
Inflammatory response and stress response as quantified by IL-8 serum levels. Blood sample collection will take place in both study groups
Surgical Stress Response - IL-10 - preoperatively
Time Frame: Preoperatively (as a baseline)
Inflammatory response and stress response as quantified by IL-10 serum levels. Blood sample collection will take place in both study groups
Surgical Stress Response - TNF-a - end of surgery
Time Frame: End of surgery (end of placement of last suture/ surgical clip on patient)
Inflammatory response and stress response as quantified by TNF-a serum levels. Blood sample collection will take place in both study groups
Surgical Stress Response - WBC - 24 hours after the end of surgery
Time Frame: 24 hours after the end of surgery (end of placement of last suture/ surgical clip on patient)
Inflammatory response and stress response as quantified by WBC count. Blood sample collection will take place in both study groups
Surgical Stress Response - AVP - preoperatively
Time Frame: Preoperatively (as a baseline)
Inflammatory response and stress response as quantified by AVP serum levels. Blood sample collection will take place in both study groups
Surgical Stress Response - AVP - end of surgery
Time Frame: End of surgery (end of placement of last suture/ surgical clip on patient)
Inflammatory response and stress response as quantified by AVP serum levels. Blood sample collection will take place in both study groups
Surgical Stress Response - HIF-1α - 24 hours after the end of surgery
Time Frame: 24 hours after the end of surgery (end of placement of last suture/ surgical clip on patient)
Inflammatory response and stress response as quantified by HIF-1α serum levels. Blood sample collection will take place in both study groups
Surgical Stress Response - VEGF- end of surgery
Time Frame: End of surgery (end of placement of last suture/ surgical clip on patient)
Inflammatory response and stress response as quantified by VEGF serum levels. Blood sample collection will take place in both study groups
Haemodynamic Stability - Mean PR
Time Frame: Every 20 seconds from anesthesia induction, until the end of surgery (end of placement of last suture/ surgical clip on patient), assessed up to 8 hours]
Haemodynamic Stability as quantified by hemodynamic markers, specifically Pulse Rate - PR. Data will be collected from a pulse contour analysis monitor, and values will be collected every 20 seconds. Mean PR will be reported for each patient, extracted from the collected data.
Surgical Stress Response - AVP - 24 hours after the end of surgery
Time Frame: 24 hours after the end of surgery (end of placement of last suture/ surgical clip on patient)
Inflammatory response and stress response as quantified by AVP serum levels. Blood sample collection will take place in both study groups
Surgical Stress Response - cortisol - preoperatively
Time Frame: Preoperatively (as a baseline)
Inflammatory response and stress response as quantified by cortisol serum levels. Blood sample collection will take place in both study groups
Surgical Stress Response - cortisol - 24 hours after the end of surgery
Time Frame: 24 hours after the end of surgery (end of placement of last suture/ surgical clip on patient)
Inflammatory response and stress response as quantified by cortisol serum levels. Blood sample collection will take place in both study groups
Surgical Stress Response - VEGF- preoperatively
Time Frame: Preoperatively (as a baseline)
Inflammatory response and stress response as quantified by VEGF serum levels. Blood sample collection will take place in both study groups
Surgical Stress Response - NF-κB - preoperatively
Time Frame: Preoperatively (as a baseline)
Inflammatory response and stress response as quantified by NF-κB serum levels. Blood sample collection will take place in both study groups
Surgical Stress Response - cortisol - end of surgery
Time Frame: End of surgery (end of placement of last suture/ surgical clip on patient)
Inflammatory response and stress response as quantified by cortisol serum levels. Blood sample collection will take place in both study groups
Surgical Stress Response - HIF-1α - end of surgery
Time Frame: End of surgery (end of placement of last suture/ surgical clip on patient)
Inflammatory response and stress response as quantified by HIF-1α serum levels. Blood sample collection will take place in both study groups
Surgical Stress Response - HIF-1α- preoperatively
Time Frame: Preoperatively (as a baseline)
Inflammatory response and stress response as quantified by HIF-1α serum levels. Blood sample collection will take place in both study groups
Surgical Stress Response - VEGF - 24 hours after the end of surgery
Time Frame: 24 hours after the end of surgery (end of placement of last suture/ surgical clip on patient)
Inflammatory response and stress response as quantified by VEGF serum levels. Blood sample collection will take place in both study groups
Haemodynamic Stability - Maximum SBP
Time Frame: Every 20 seconds from anesthesia induction, until the end of surgery (end of placement of last suture/ surgical clip on patient), assessed up to 8 hours]
Haemodynamic Stability as quantified by hemodynamic markers, specifically Systolic Blood Pressure - SBP. Data will be collected from a pulse contour analysis monitor, and values will be collected every 20 seconds. Maximum SBP will be reported for each patient, extracted from the collected data.
Haemodynamic Stability - Standard Deviation SBP
Time Frame: Every 20 seconds from anesthesia induction, until the end of surgery (end of placement of last suture/ surgical clip on patient), assessed up to 8 hours]
Haemodynamic Stability as quantified by hemodynamic markers, specifically Systolic Blood Pressure - SBP. Data will be collected from a pulse contour analysis monitor, and values will be collected every 20 seconds. Standard Deviation SBP will be reported for each patient, extracted from the collected data.
Haemodynamic Stability - SBP Change Induction
Time Frame: 1 minute after anesthesia induction, compared to 1 minute prior
Haemodynamic Stability as quantified by hemodynamic markers, specifically Systolic Blood Pressure change 1 minute after anesthesia induction, compared to 1 minute prior. Data will be collected from a pulse contour analysis monitor.
Haemodynamic Stability - SBP Change Incision
Time Frame: 1 minute after surgical incision, compared to 1 minute prior
Haemodynamic Stability as quantified by hemodynamic markers, specifically Systolic Blood Pressure change 1 minute after surgical incision, compared to 1 minute prior. Data will be collected from a pulse contour analysis monitor.
Haemodynamic Stability - Mean DBP
Time Frame: Every 20 seconds from anesthesia induction, until the end of surgery (end of placement of last suture/ surgical clip on patient), assessed up to 8 hours]
Haemodynamic Stability as quantified by hemodynamic markers, specifically Diastolic Blood Pressure - DBP. Data will be collected from a pulse contour analysis monitor, and values will be collected every 20 seconds. Mean DBP will be reported for each patient, extracted from the collected data.
Haemodynamic Stability - Minimum DBP
Time Frame: Every 20 seconds from anesthesia induction, until the end of surgery (end of placement of last suture/ surgical clip on patient), assessed up to 8 hours]
Haemodynamic Stability as quantified by hemodynamic markers, specifically Diastolic Blood Pressure - DBP. Data will be collected from a pulse contour analysis monitor, and values will be collected every 20 seconds. Minimum DBP will be reported for each patient, extracted from the collected data.
Surgical Stress Response - NF-κB - end of surgery
Time Frame: End of surgery (end of placement of last suture/ surgical clip on patient)
Inflammatory response and stress response as quantified by NF-κB serum levels. Blood sample collection will take place in both study groups
Surgical Stress Response - NF-κB - 24 hours after the end of surgery
Time Frame: 24 hours after the end of surgery (end of placement of last suture/ surgical clip on patient)
Inflammatory response and stress response as quantified by NF-κB serum levels. Blood sample collection will take place in both study groups
Haemodynamic Stability - Minimum PR
Time Frame: Every 20 seconds from anesthesia induction, until the end of surgery (end of placement of last suture/ surgical clip on patient), assessed up to 8 hours]
Haemodynamic Stability as quantified by hemodynamic markers, specifically Pulse Rate - PR. Data will be collected from a pulse contour analysis monitor, and values will be collected every 20 seconds. Minimum PR will be reported for each patient, extracted from the collected data.
Haemodynamic Stability - Maximum PR
Time Frame: Every 20 seconds from anesthesia induction, until the end of surgery (end of placement of last suture/ surgical clip on patient), assessed up to 8 hours]
Haemodynamic Stability as quantified by hemodynamic markers, specifically Pulse Rate - PR. Data will be collected from a pulse contour analysis monitor, and values will be collected every 20 seconds. Maximum PR will be reported for each patient, extracted from the collected data.
Haemodynamic Stability - Standard Deviation PR
Time Frame: Every 20 seconds from anesthesia induction, until the end of surgery (end of placement of last suture/ surgical clip on patient), assessed up to 8 hours]
Haemodynamic Stability as quantified by hemodynamic markers, specifically Pulse Rate - PR. Data will be collected from a pulse contour analysis monitor, and values will be collected every 20 seconds. Standard Deviation PR will be reported for each patient, extracted from the collected data.
Haemodynamic Stability - PR Change Induction
Time Frame: 1 minute after anesthesia induction, compared to 1 minute prior
Haemodynamic Stability as quantified by hemodynamic markers, specifically Pulse Rate change 1 minute after anesthesia induction, compared to 1 minute prior. Data will be collected from a pulse contour analysis monitor.
Haemodynamic Stability - PR Change Incision
Time Frame: 1 minute after surgical incision, compared to 1 minute prior
Haemodynamic Stability as quantified by hemodynamic markers, specifically Pulse Rate change 1 minute after surgical incision, compared to 1 minute prior. Data will be collected from a pulse contour analysis monitor.
Haemodynamic Stability - Mean SBP
Time Frame: Every 20 seconds from anesthesia induction, until the end of surgery (end of placement of last suture/ surgical clip on patient), assessed up to 8 hours]
Haemodynamic Stability as quantified by hemodynamic markers, specifically Systolic Blood Pressure - SBP. Data will be collected from a pulse contour analysis monitor, and values will be collected every 20 seconds. Mean SBP will be reported for each patient, extracted from the collected data.
Haemodynamic Stability - Minimum SBP
Time Frame: Every 20 seconds from anesthesia induction, until the end of surgery (end of placement of last suture/ surgical clip on patient), assessed up to 8 hours]
Haemodynamic Stability as quantified by hemodynamic markers, specifically Systolic Blood Pressure - SBP. Data will be collected from a pulse contour analysis monitor, and values will be collected every 20 seconds. Minimum SBP will be reported for each patient, extracted from the collected data.
Haemodynamic Stability - Maximum DBP
Time Frame: Every 20 seconds from anesthesia induction, until the end of surgery (end of placement of last suture/ surgical clip on patient), assessed up to 8 hours]
Haemodynamic Stability as quantified by hemodynamic markers, specifically Diastolic Blood Pressure - DBP. Data will be collected from a pulse contour analysis monitor, and values will be collected every 20 seconds. Maximum DBP will be reported for each patient, extracted from the collected data.
Haemodynamic Stability - Standard Deviation DBP
Time Frame: Every 20 seconds from anesthesia induction, until the end of surgery (end of placement of last suture/ surgical clip on patient), assessed up to 8 hours]
Haemodynamic Stability as quantified by hemodynamic markers, specifically Diastolic Blood Pressure - DBP. Data will be collected from a pulse contour analysis monitor, and values will be collected every 20 seconds. Standard Deviation DBP will be reported for each patient, extracted from the collected data.
Haemodynamic Stability - DBP change induction
Time Frame: 1 minute after anesthesia induction, compared to 1 minute prior
Haemodynamic Stability as quantified by hemodynamic markers, specifically Diastolic Blood Pressure change 1 minute after anesthesia induction, compared to 1 minute prior. Data will be collected from a pulse contour analysis monitor.
Haemodynamic Stability - DBP change incision
Time Frame: 1 minute after surgical incision, compared to 1 minute prior
Haemodynamic Stability as quantified by hemodynamic markers, specifically Diastolic Blood Pressure change 1 minute after surgical incision, compared to 1 minute prior. Data will be collected from a pulse contour analysis monitor.
Haemodynamic Stability - Mean MBP
Time Frame: Every 20 seconds from anesthesia induction, until the end of surgery (end of placement of last suture/ surgical clip on patient), assessed up to 8 hours]
Haemodynamic Stability as quantified by hemodynamic markers, specifically Mean Blood Pressure - MBP. Data will be collected from a pulse contour analysis monitor, and values will be collected every 20 seconds. Mean MBP will be reported for each patient, extracted from the collected data.
Haemodynamic Stability - Minimum MBP
Time Frame: Every 20 seconds from anesthesia induction, until the end of surgery (end of placement of last suture/ surgical clip on patient), assessed up to 8 hours]
Haemodynamic Stability as quantified by hemodynamic markers, specifically Mean Blood Pressure - MBP. Data will be collected from a pulse contour analysis monitor, and values will be collected every 20 seconds. Minimum MBP will be reported for each patient, extracted from the collected data.
Haemodynamic Stability - Maximum MBP
Time Frame: Every 20 seconds from anesthesia induction, until the end of surgery (end of placement of last suture/ surgical clip on patient), assessed up to 8 hours]
Haemodynamic Stability as quantified by hemodynamic markers, specifically Mean Blood Pressure - MBP. Data will be collected from a pulse contour analysis monitor, and values will be collected every 20 seconds. Maximum MBP will be reported for each patient, extracted from the collected data.
Haemodynamic Stability - Standard Deviation MBP
Time Frame: Every 20 seconds from anesthesia induction, until the end of surgery (end of placement of last suture/ surgical clip on patient), assessed up to 8 hours]
Haemodynamic Stability as quantified by hemodynamic markers, specifically Mean Blood Pressure - MBP. Data will be collected from a pulse contour analysis monitor, and values will be collected every 20 seconds. Standard Deviation MBP will be reported for each patient, extracted from the collected data.
Haemodynamic Stability - MBP change induction
Time Frame: 1 minute after anesthesia induction, compared to 1 minute prior
Haemodynamic Stability as quantified by hemodynamic markers, specifically Mean Blood Pressure change 1 minute after anesthesia induction, compared to 1 minute prior. Data will be collected from a pulse contour analysis monitor.
Haemodynamic Stability - MBP change incision
Time Frame: 1 minute after surgical incision, compared to 1 minute prior
Haemodynamic Stability as quantified by hemodynamic markers, specifically Mean Blood Pressure change 1 minute after surgical incision, compared to 1 minute prior. Data will be collected from a pulse contour analysis monitor.
Haemodynamic Stability - Mean CO
Time Frame: Every 20 seconds from anesthesia induction, until the end of surgery (end of placement of last suture/ surgical clip on patient), assessed up to 8 hours]
Haemodynamic Stability as quantified by hemodynamic markers, specifically Cardiac Output - CO. Data will be collected from a pulse contour analysis monitor, and values will be collected every 20 seconds. Mean CO will be reported for each patient, extracted from the collected data.
Haemodynamic Stability - Minimum CO
Time Frame: Every 20 seconds from anesthesia induction, until the end of surgery (end of placement of last suture/ surgical clip on patient), assessed up to 8 hours]
Haemodynamic Stability as quantified by hemodynamic markers, specifically Cardiac Output - CO. Data will be collected from a pulse contour analysis monitor, and values will be collected every 20 seconds. Minimum CO will be reported for each patient, extracted from the collected data.
Haemodynamic Stability - Maximum CO
Time Frame: Every 20 seconds from anesthesia induction, until the end of surgery (end of placement of last suture/ surgical clip on patient), assessed up to 8 hours]
Haemodynamic Stability as quantified by hemodynamic markers, specifically Cardiac Output - CO. Data will be collected from a pulse contour analysis monitor, and values will be collected every 20 seconds. Maximum CO will be reported for each patient, extracted from the collected data.
Haemodynamic Stability - Standard Deviation CO
Time Frame: Every 20 seconds from anesthesia induction, until the end of surgery (end of placement of last suture/ surgical clip on patient), assessed up to 8 hours]
Haemodynamic Stability as quantified by hemodynamic markers, specifically Cardiac Output - CO. Data will be collected from a pulse contour analysis monitor, and values will be collected every 20 seconds. Standard Deviation CO will be reported for each patient, extracted from the collected data.
Haemodynamic Stability - Mean CI
Time Frame: Every 20 seconds from anesthesia induction, until the end of surgery (end of placement of last suture/ surgical clip on patient), assessed up to 8 hours]
Haemodynamic Stability as quantified by hemodynamic markers, specifically Cardiac Index - CI. Data will be collected from a pulse contour analysis monitor, and values will be collected every 20 seconds. Mean CI will be reported for each patient, extracted from the collected data.
Haemodynamic Stability - Minimum CI
Time Frame: Every 20 seconds from anesthesia induction, until the end of surgery (end of placement of last suture/ surgical clip on patient), assessed up to 8 hours]
Haemodynamic Stability as quantified by hemodynamic markers, specifically Cardiac Index - CI. Data will be collected from a pulse contour analysis monitor, and values will be collected every 20 seconds. Minimum CI will be reported for each patient, extracted from the collected data.
Haemodynamic Stability - Maximum CI
Time Frame: Every 20 seconds from anesthesia induction, until the end of surgery (end of placement of last suture/ surgical clip on patient), assessed up to 8 hours]
Haemodynamic Stability as quantified by hemodynamic markers, specifically Cardiac Index - CI. Data will be collected from a pulse contour analysis monitor, and values will be collected every 20 seconds. Maximum CI will be reported for each patient, extracted from the collected data.
Haemodynamic Stability - Standard Deviation CI
Time Frame: Every 20 seconds from anesthesia induction, until the end of surgery (end of placement of last suture/ surgical clip on patient), assessed up to 8 hours]
Haemodynamic Stability as quantified by hemodynamic markers, specifically Cardiac Index - CI. Data will be collected from a pulse contour analysis monitor, and values will be collected every 20 seconds. Standard Deviation CI will be reported for each patient, extracted from the collected data.
Haemodynamic Stability - Mean SV
Time Frame: Every 20 seconds from anesthesia induction, until the end of surgery (end of placement of last suture/ surgical clip on patient), assessed up to 8 hours]
Haemodynamic Stability as quantified by hemodynamic markers, specifically Stroke Volume - SV. Data will be collected from a pulse contour analysis monitor, and values will be collected every 20 seconds. Mean SV will be reported for each patient, extracted from the collected data.
Haemodynamic Stability - Minimum SV
Time Frame: Every 20 seconds from anesthesia induction, until the end of surgery (end of placement of last suture/ surgical clip on patient), assessed up to 8 hours]
Haemodynamic Stability as quantified by hemodynamic markers, specifically Stroke Volume - SV. Data will be collected from a pulse contour analysis monitor, and values will be collected every 20 seconds. Minimum SV will be reported for each patient, extracted from the collected data.
Haemodynamic Stability - Maximum SV
Time Frame: Every 20 seconds from anesthesia induction, until the end of surgery (end of placement of last suture/ surgical clip on patient), assessed up to 8 hours]
Haemodynamic Stability as quantified by hemodynamic markers, specifically Stroke Volume - SV. Data will be collected from a pulse contour analysis monitor, and values will be collected every 20 seconds. Maximum SV will be reported for each patient, extracted from the collected data.
Haemodynamic Stability - Standard Deviation SV
Time Frame: Every 20 seconds from anesthesia induction, until the end of surgery (end of placement of last suture/ surgical clip on patient), assessed up to 8 hours]
Haemodynamic Stability as quantified by hemodynamic markers, specifically Stroke Volume - SV. Data will be collected from a pulse contour analysis monitor, and values will be collected every 20 seconds. Standard Deviation SV will be reported for each patient, extracted from the collected data.
Haemodynamic Stability - Mean SVV
Time Frame: Every 20 seconds from anesthesia induction, until the end of surgery (end of placement of last suture/ surgical clip on patient), assessed up to 8 hours]
Haemodynamic Stability as quantified by hemodynamic markers, specifically Stroke Volume Variation - SVV. Data will be collected from a pulse contour analysis monitor, and values will be collected every 20 seconds. Mean SVV will be reported for each patient, extracted from the collected data.
Haemodynamic Stability - Minimum SVV
Time Frame: Every 20 seconds from anesthesia induction, until the end of surgery (end of placement of last suture/ surgical clip on patient), assessed up to 8 hours]
Haemodynamic Stability as quantified by hemodynamic markers, specifically Stroke Volume Variation - SVV. Data will be collected from a pulse contour analysis monitor, and values will be collected every 20 seconds. Minimum SVV will be reported for each patient, extracted from the collected data.
Haemodynamic Stability - Maximum SVV
Time Frame: Every 20 seconds from anesthesia induction, until the end of surgery (end of placement of last suture/ surgical clip on patient), assessed up to 8 hours]
Haemodynamic Stability as quantified by hemodynamic markers, specifically Stroke Volume Variation - SVV. Data will be collected from a pulse contour analysis monitor, and values will be collected every 20 seconds. Maximum SVV will be reported for each patient, extracted from the collected data.
Haemodynamic Stability - Standard Deviation SVV
Time Frame: Every 20 seconds from anesthesia induction, until the end of surgery (end of placement of last suture/ surgical clip on patient), assessed up to 8 hours]
Haemodynamic Stability as quantified by hemodynamic markers, specifically Stroke Volume Variation - SVV. Data will be collected from a pulse contour analysis monitor, and values will be collected every 20 seconds. Standard Deviation SVV will be reported for each patient, extracted from the collected data.
Haemodynamic Stability - Mean SVI
Time Frame: Every 20 seconds from anesthesia induction, until the end of surgery (end of placement of last suture/ surgical clip on patient), assessed up to 8 hours]
Haemodynamic Stability as quantified by hemodynamic markers, specifically Stroke Volume Index - SVI. Data will be collected from a pulse contour analysis monitor, and values will be collected every 20 seconds. Mean SVI will be reported for each patient, extracted from the collected data.
Haemodynamic Stability - Minimum SVI
Time Frame: Every 20 seconds from anesthesia induction, until the end of surgery (end of placement of last suture/ surgical clip on patient), assessed up to 8 hours]
Haemodynamic Stability as quantified by hemodynamic markers, specifically Stroke Volume Index - SVI. Data will be collected from a pulse contour analysis monitor, and values will be collected every 20 seconds. Minimum SVI will be reported for each patient, extracted from the collected data.
Haemodynamic Stability - Maximum SVI
Time Frame: Every 20 seconds from anesthesia induction, until the end of surgery (end of placement of last suture/ surgical clip on patient), assessed up to 8 hours]
Haemodynamic Stability as quantified by hemodynamic markers, specifically Stroke Volume Index - SVI. Data will be collected from a pulse contour analysis monitor, and values will be collected every 20 seconds. Maximum SVI will be reported for each patient, extracted from the collected data.
Haemodynamic Stability - Standard Deviation SVI
Time Frame: Every 20 seconds from anesthesia induction, until the end of surgery (end of placement of last suture/ surgical clip on patient), assessed up to 8 hours]
Haemodynamic Stability as quantified by hemodynamic markers, specifically Stroke Volume Index - SVI. Data will be collected from a pulse contour analysis monitor, and values will be collected every 20 seconds. Standard Deviation SVI will be reported for each patient, extracted from the collected data.
Haemodynamic Stability - Tachycardia
Time Frame: Intraoperatively, assessed up to 4 hours.
Intraoperative Tachycardia (defined as PR≥ 100 bpm), with episodes lasting ≥1 minute. Data will be reported in total seconds of intraoperative tachycardia.
Haemodynamic Stability - Fluid requirements - Platelets - Intraoperatively
Time Frame: Intraoperatively, assessed up to 6 hours.
Haemodynamic Stability as quantified by hemodynamic markers, specifically Platelet unit Requirements.
Haemodynamic Stability - Bradycardia
Time Frame: Intraoperatively, assessed up to 4 hours.
Intraoperative Bradycardia (defined as PR≤ 60 bpm), with episodes lasting ≥1 minute. Data will be reported in total seconds of intraoperative bradycardia.
Haemodynamic Stability - Fluid requirements - Concentrated RBCs - Intraoperatively
Time Frame: Intraoperatively, assessed up to 6 hours.
Haemodynamic Stability as quantified by hemodynamic markers, specifically Concentrated Red Blood Cell unit Requirements.
Haemodynamic Stability - Fluid Balance - Intraoperatively
Time Frame: Intraoperatively, assessed up to 6 hours.
Haemodynamic Stability as quantified by hemodynamic markers, specifically Fluid Balance
Haemodynamic Stability - Vasoactive Requirements - Noradrenaline - Intraoperatively
Time Frame: Intraoperatively, assessed up to 6 hours.
Haemodynamic Stability as quantified by hemodynamic markers, specifically Noradrenaline requirements
Haemodynamic Stability - Hypotension
Time Frame: Intraoperatively, assessed up to 6 hours.
Intraoperative Hypotension (defined as SBP≤100mmHg or ≤70% of preoperative Baseline), with episodes lasting ≥1 minute. All patients will have a 5 minute preoperative SBP baseline, with measurements every 20 seconds. Intraoperative data will be compared to the mean preoperative 5 minute SPB baseline. Data will be reported in total seconds of intraoperative hypotension.
Haemodynamic Stability - Blood Loss - Intraoperatively
Time Frame: Intraoperatively, assessed up to 6 hours.
Haemodynamic Stability as quantified by hemodynamic markers, specifically Blood Loss
Haemodynamic Stability - Vasoactive Requirements - Adrenaline - Intraoperatively
Time Frame: Intraoperatively, assessed up to 6 hours.
Haemodynamic Stability as quantified by hemodynamic markers, specifically Adrenaline requirements
Haemodynamic Stability - Hypertension
Time Frame: Intraoperatively, assessed up to 6 hours.
Intraoperative Hypertension (defined as SBP ≥130% of preoperative Baseline), with episodes lasting ≥1 minute. All patients will have a 5 minute preoperative SBP baseline, with measurements every 20 seconds. Intraoperative data will be compared to the mean preoperative 5 minute SPB baseline. Data will be reported in total seconds of intraoperative hypertension.
Haemodynamic Stability - Fluid requirements - Crystalloids - Intraoperatively
Time Frame: Intraoperatively, assessed up to 6 hours.
Haemodynamic Stability as quantified by hemodynamic markers, specifically Crystalloid Fluid Requirements.
Haemodynamic Stability - Fluid requirements - Colloids - Intraoperatively
Time Frame: Intraoperatively, assessed up to 6 hours.
Haemodynamic Stability as quantified by hemodynamic markers, specifically Colloid Fluid Requirements.
Haemodynamic Stability - Fluid requirements - Plasma - Intraoperatively
Time Frame: Intraoperatively, assessed up to 6 hours.
Haemodynamic Stability as quantified by hemodynamic markers, specifically Plasma unit Requirements.
Haemodynamic Stability - Vasoactive Requirements - Ephedrine - Intraoperatively
Time Frame: Intraoperatively, assessed up to 6 hours.
Haemodynamic Stability as quantified by hemodynamic markers, specifically Ephedrine requirements
Haemodynamic Stability - Vasoactive Requirements - Dopamine - Intraoperatively
Time Frame: Intraoperatively, assessed up to 6 hours.
Haemodynamic Stability as quantified by hemodynamic markers, specifically Dopamine requirements
Haemodynamic Stability - Vasoactive Requirements - Phenylephrine - Intraoperatively
Time Frame: Intraoperatively, assessed up to 6 hours.
Haemodynamic Stability as quantified by hemodynamic markers, specifically Phenylephrine requirements
Haemodynamic Stability - Vasoactive Requirements - Dobutamine - Intraoperatively
Time Frame: Intraoperatively, assessed up to 6 hours.
Haemodynamic Stability as quantified by hemodynamic markers, specifically Dobutamine requirements
Haemodynamic Stability - Vasoactive Requirements - Nitroglycerine - Intraoperatively
Time Frame: Intraoperatively, assessed up to 6 hours.
Haemodynamic Stability as quantified by hemodynamic markers, specifically Nitroglycerine requirements
Neutrophil to Lymphocyte ratio (NLR)
Time Frame: Preoperatively
Neutrophil to Lymphocyte ratio (NLR) is a prognostic index that predicts patients' overall survival. Higher NLR has been correlated with worse outcome.
Platelet to Lymphocyte ratio (PLR)
Time Frame: Preoperatively
Platelet to Lymphocyte ratio (PLR) is a prognostic index that predicts patients' overall survival. Higher PLR has been correlated with worse outcome.
Lymphocyte to monocyte ratio (LMR)
Time Frame: Preoperatively
Lymphocyte to monocyte ratio (LMR) is a prognostic index that predicts patients' overall survival. Lower LMR has been correlated with worse outcome.
Surgical Stress Response - IL-10 - end of surgery
Time Frame: End of surgery (end of placement of last suture/ surgical clip on patient)
Inflammatory response and stress response as quantified by IL-10 serum levels. Blood sample collection will take place in both study groups
Surgical Stress Response - TNF-a - 24 hours after the end of surgery
Time Frame: 24 hours after the end of surgery (end of placement of last suture/ surgical clip on patient)
Inflammatory response and stress response as quantified by TNF-a serum levels. Blood sample collection will take place in both study groups
Surgical Stress Response - CRP - end of surgery
Time Frame: End of surgery (end of placement of last suture/ surgical clip on patient)
Inflammatory response and stress response as quantified by CRP serum levels. Blood sample collection will take place in both study groups
Surgical Stress Response - CRP - 24 hours after the end of surgery
Time Frame: 24 hours after the end of surgery (end of placement of last suture/ surgical clip on patient)
Inflammatory response and stress response as quantified by CRP serum levels. Blood sample collection will take place in both study groups
Surgical Stress Response - WBC - preoperatively
Time Frame: Preoperatively (as a baseline)
Inflammatory response and stress response as quantified by WBC count. Blood sample collection will take place in both study groups
Surgical Stress Response - WBC - end of surgery
Time Frame: End of surgery (end of placement of last suture/ surgical clip on patient)
Inflammatory response and stress response as quantified by WBC count. Blood sample collection will take place in both study groups
Secondary Outcomes
- Acute postoperative pain - Numerical Rating Scale (NRS) - Immediately Postoperatively(Immediately postoperatively)
- Acute postoperative pain - Numerical Rating Scale (NRS) - First postoperative day(First postoperative day)
- Acute postoperative pain - Numerical Rating Scale (NRS) - Second postoperative day(Second postoperative day)
- Acute postoperative pain - Numerical Rating Scale (NRS) - Third postoperative day(Third postoperative day)
- Acute postoperative pain - Clinically Aligned Pain Assessment Tool (CAPA) - Comfort - Tolerable with discomfort - Second postoperative day(Second postoperative day)
- Acute postoperative pain - Clinically Aligned Pain Assessment Tool (CAPA) - Change in Pain - About the same - First postoperative day(First postoperative day)
- Acute postoperative pain - Clinically Aligned Pain Assessment Tool (CAPA) - Pain control - Inadequate pain control - First postoperative day(First postoperative day)
- Acute postoperative pain - Clinically Aligned Pain Assessment Tool (CAPA) - Pain control - Effective, just about right - First postoperative day(First postoperative day)
- Acute postoperative pain - Clinically Aligned Pain Assessment Tool (CAPA) - Pain control - Effective, just about right - Third postoperative day(Third postoperative day)
- Acute postoperative pain - Critical Care Pain Observation Tool (CPOT) - Immediately Postoperatively(Immediately postoperatively)
- Acute postoperative pain - Clinically Aligned Pain Assessment Tool (CAPA) - Comfort - Intolerable - First postoperative day(First postoperative day)
- Acute postoperative pain - Clinically Aligned Pain Assessment Tool (CAPA) - Change in Pain - About the same - Second postoperative day(Second postoperative day)
- Acute postoperative pain - Clinically Aligned Pain Assessment Tool (CAPA) - Pain control - Inadequate pain control - Third postoperative day(Third postoperative day)
- Acute postoperative pain - Critical Care Pain Observation Tool (CPOT) - First postoperative day(First postoperative day)
- Acute postoperative pain - Critical Care Pain Observation Tool (CPOT) - Second postoperative day(Second postoperative day)
- Acute postoperative pain - Critical Care Pain Observation Tool (CPOT) - Third postoperative day(Third postoperative day)
- Acute postoperative pain - Clinically Aligned Pain Assessment Tool (CAPA) - Comfort - Intolerable - Second postoperative day(Second postoperative day)
- Acute postoperative pain - Clinically Aligned Pain Assessment Tool (CAPA) - Comfort - Intolerable - Third postoperative day(Third postoperative day)
- Acute postoperative pain - Clinically Aligned Pain Assessment Tool (CAPA) - Comfort - Tolerable with discomfort - First postoperative day(First postoperative day)
- Acute postoperative pain - Clinically Aligned Pain Assessment Tool (CAPA) - Comfort - Tolerable with discomfort - Third postoperative day(Third postoperative day)
- Acute postoperative pain - Clinically Aligned Pain Assessment Tool (CAPA) - Comfort - Comfortably manageable - First postoperative day(First postoperative day)
- Acute postoperative pain - Clinically Aligned Pain Assessment Tool (CAPA) - Comfort - Comfortably manageable - Second postoperative day(Second postoperative day)
- Acute postoperative pain - Clinically Aligned Pain Assessment Tool (CAPA) - Comfort - Comfortably manageable - Third postoperative day(Third postoperative day)
- Acute postoperative pain - Clinically Aligned Pain Assessment Tool (CAPA) - Comfort - Negligible Pain - First postoperative day(First postoperative day)
- Acute postoperative pain - Clinically Aligned Pain Assessment Tool (CAPA) - Comfort - Negligible Pain - Second postoperative day(Second postoperative day)
- Acute postoperative pain - Clinically Aligned Pain Assessment Tool (CAPA) - Comfort - Negligible Pain - Third postoperative day(Third postoperative day)
- Acute postoperative pain - Clinically Aligned Pain Assessment Tool (CAPA) - Change in Pain - Getting Worse - First postoperative day(First postoperative day)
- Acute postoperative pain - Clinically Aligned Pain Assessment Tool (CAPA) - Change in Pain - About the same - Third postoperative day(Third postoperative day)
- Acute postoperative pain - Clinically Aligned Pain Assessment Tool (CAPA) - Change in Pain - Getting Worse - Second postoperative day(Second postoperative day)
- Acute postoperative pain - Clinically Aligned Pain Assessment Tool (CAPA) - Change in Pain - Getting better - Second postoperative day(Second postoperative day)
- Acute postoperative pain - Clinically Aligned Pain Assessment Tool (CAPA) - Pain control - Inadequate pain control - Second postoperative day(Second postoperative day)
- Acute postoperative pain - Clinically Aligned Pain Assessment Tool (CAPA) - Change in Pain - Getting Worse - Third postoperative day(Third postoperative day)
- Acute postoperative pain - Clinically Aligned Pain Assessment Tool (CAPA) - Pain control - Effective, just about right - Second postoperative day(Second postoperative day)
- Acute postoperative pain - Clinically Aligned Pain Assessment Tool (CAPA) - Pain control - Would like to reduce medication - First postoperative day(First postoperative day)
- Acute postoperative pain - Clinically Aligned Pain Assessment Tool (CAPA) - Change in Pain - Getting better - First postoperative day(First postoperative day)
- Acute postoperative pain - Clinically Aligned Pain Assessment Tool (CAPA) - Change in Pain - Getting better - Third postoperative day(Third postoperative day)
- Acute postoperative pain - Clinically Aligned Pain Assessment Tool (CAPA) - Pain control - Would like to reduce medication - Second postoperative day(Second postoperative day)
- Acute postoperative pain - Clinically Aligned Pain Assessment Tool (CAPA) - Pain control - Would like to reduce medication - Third postoperative day(Third postoperative day)
- Acute postoperative pain - Clinically Aligned Pain Assessment Tool (CAPA) - Functioning - Can't do anything because of pain - First postoperative day(First postoperative day)
- Acute postoperative pain - Clinically Aligned Pain Assessment Tool (CAPA) - Functioning - Can't do anything because of pain - Second postoperative day(Second postoperative day)
- Acute postoperative pain - Clinically Aligned Pain Assessment Tool (CAPA) - Functioning - Can't do anything because of pain - Third postoperative day(Third postoperative day)
- Acute postoperative pain - Clinically Aligned Pain Assessment Tool (CAPA) - Functioning - Pain keeps me from doing most of what I need to do - First postoperative day(First postoperative day)
- Acute postoperative pain - Clinically Aligned Pain Assessment Tool (CAPA) - Functioning - Pain keeps me from doing most of what I need to do - Second postoperative day(Second postoperative day)
- Acute postoperative pain - Clinically Aligned Pain Assessment Tool (CAPA) - Functioning - Pain keeps me from doing most of what I need to do - Third postoperative day(Third postoperative day)
- Acute postoperative pain - Clinically Aligned Pain Assessment Tool (CAPA) - Functioning - Can do most things, but pain gets in the way of some - First postoperative day(First postoperative day)
- Acute postoperative pain - Clinically Aligned Pain Assessment Tool (CAPA) - Functioning - Can do most things, but pain gets in the way of some - Second postoperative day(Second postoperative day)
- Acute postoperative pain - Clinically Aligned Pain Assessment Tool (CAPA) - Functioning - Can do most things, but pain gets in the way of some - Third postoperative day(Third postoperative day)
- Acute postoperative pain - Clinically Aligned Pain Assessment Tool (CAPA) - Functioning - Can do everything I need to do - First postoperative day(First postoperative day)
- Acute postoperative pain - Clinically Aligned Pain Assessment Tool (CAPA) - Functioning - Can do everything I need to do - Second postoperative day(Second postoperative day)
- Acute postoperative pain - Clinically Aligned Pain Assessment Tool (CAPA) - Functioning - Can do everything I need to do - Third postoperative day(Third postoperative day)
- Acute postoperative pain - Clinically Aligned Pain Assessment Tool (CAPA) - Sleep - Awake with pain most of the night - First postoperative day(First postoperative day)
- Acute postoperative pain - Clinically Aligned Pain Assessment Tool (CAPA) - Sleep - Awake with pain most of the night - Second postoperative day(Second postoperative day)
- Acute postoperative pain - Clinically Aligned Pain Assessment Tool (CAPA) - Sleep - Awake with pain most of the night - Third postoperative day(Third postoperative day)
- Acute postoperative pain - Clinically Aligned Pain Assessment Tool (CAPA) - Sleep - Awake with occasional pain - First postoperative day(First postoperative day)
- Acute postoperative pain - Clinically Aligned Pain Assessment Tool (CAPA) - Sleep - Awake with occasional pain - Second postoperative day(Second postoperative day)
- Acute postoperative pain - Clinically Aligned Pain Assessment Tool (CAPA) - Sleep - Awake with occasional pain - Third postoperative day(Third postoperative day)
- Acute postoperative pain - Clinically Aligned Pain Assessment Tool (CAPA) - Sleep - Normal sleep - First postoperative day(First postoperative day)
- Acute postoperative pain - Clinically Aligned Pain Assessment Tool (CAPA) - Sleep - Normal sleep - Second postoperative day(Second postoperative day)
- Acute postoperative pain - Clinically Aligned Pain Assessment Tool (CAPA) - Sleep - Normal sleep - Third postoperative day(Third postoperative day)
- Analgesic Requirements - First postoperative day(First postoperative day)
- Analgesic Requirements - Second postoperative day(Second postoperative day)
- Analgesic Requirements - Third postoperative day(Third postoperative day)
- Postoperative Pulmonary Complications - Aspiration Pneumonitis(From the first postoperative day, until the fifth postoperative day)
- Postoperative Pulmonary Complications - Moderate respiratory failure(From the first postoperative day, until the fifth postoperative day)
- Postoperative Pulmonary Complications - Severe respiratory failure(From the first postoperative day, until the fifth postoperative day)
- Postoperative Pulmonary Complications - ARDS(From the first postoperative day, until the fifth postoperative day)
- Postoperative Pulmonary Complications - Pulmonary Infection(From the first postoperative day, until the fifth postoperative day)
- Postoperative Pulmonary Complications - Atelectasis(From the first postoperative day, until the fifth postoperative day)
- Postoperative Pulmonary Complications - Cardiopulmonary edema(From the first postoperative day, until the fifth postoperative day)
- Postoperative Pulmonary Complications - Pleural effusion(From the first postoperative day, until the fifth postoperative day)
- Postoperative Pulmonary Complications - Pneumothorax(From the first postoperative day, until the fifth postoperative day)
- Postoperative Pulmonary Complications - Pulmonary Infiltrates(From the first postoperative day, until the fifth postoperative day)
- Postoperative Pulmonary Complications - Prolonged air leakage(From the first postoperative day, until the fifth postoperative day)
- Postoperative Pulmonary Complications - Purulent pleuritic(From the first postoperative day, until the fifth postoperative day)
- Postoperative Pulmonary Complications - Pulmonary embolism(From the first postoperative day, until the fifth postoperative day)
- Postoperative Pulmonary Complications - Lung hemorrhage(From the first postoperative day, until the fifth postoperative day)
- Chronic postoperative pain - Pain Detect(Three months after the end of surgery)