High-altitude adaptation as a protective factor against postoperative pulmonary complications in liver resection: a prospective matched cohort study
Abstract Background High-altitude adaptation (HAA), induced by chronic hypoxia, has clinically significant cardioprotective effects; however, its impact on postoperative pulmonary complications (PPCs) in patients undergoing liver resection remains uncertain. Methods We conducted a single-center pros...
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BMC
2025-07-01
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| Series: | BMC Anesthesiology |
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| Online Access: | https://doi.org/10.1186/s12871-025-03215-7 |
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| author | Qingyong Luo Yu Zhang Shiyao Gu Li liu Si Zeng Qian Lei |
| author_facet | Qingyong Luo Yu Zhang Shiyao Gu Li liu Si Zeng Qian Lei |
| author_sort | Qingyong Luo |
| collection | DOAJ |
| description | Abstract Background High-altitude adaptation (HAA), induced by chronic hypoxia, has clinically significant cardioprotective effects; however, its impact on postoperative pulmonary complications (PPCs) in patients undergoing liver resection remains uncertain. Methods We conducted a single-center prospective matched cohort study enrolling 292 consecutive patients undergoing elective liver resection. Patients were divided into two groups based on their long-term residential altitude: high-altitude group (≥ 1500 m) and plain group (< 1500 m). Propensity score matching (1:2 ratio) was applied to control for confounding factors, including demographic variables, clinical characteristics, preoperative oxygen saturation, ARISCAT score, and surgical factors. The primary outcome was the incidence of PPCs within 7 days after surgery. Secondary outcomes included the severity of PPCs, surgical complication grading, and length of hospital stay. Statistical analysis was performed using R software and SPSS 22.0. Results After matching, 212 patients were included in the analysis. The incidence of PPCs within 7 days postoperatively in the high-altitude group was significantly lower than that in the plain group (61.5% vs. 76.1%, RR 0.80, 95% CI 0.66–0.98, P = 0.024). Furthermore, the high-altitude group showed milder complication severity and a shorter hospital stay (6 [4–8] vs. 7 [5–11] days, P = 0.005). Multivariate logistic regression analysis showed that HAA was an independent protective factor against PPCs (OR 0.31, 95% CI 0.12–0.83, P = 0.020). Further exploratory analysis revealed that during hepatic pedicle clamping, blood glucose levels remained more stable in the high-altitude group ([9.30 [7.25–11.90] vs. 10.95 [7.90–14.00] mmol/L, P < 0.001), with lower lactate accumulation after multiple clamps (1.55 [1.10–2.17] vs. 1.70 [1.10–2.50] mmol/L, P = 0.042). Conclusion HAA may reduce the incidence and severity of PPCs after liver resection, potentially due to enhanced metabolic stability associated with chronic hypoxia in high-altitude residents. Trial registration This study is registered with ChiCTR (ID: ChiCTR2200061915), registered on July 11, 2022. |
| format | Article |
| id | doaj-art-093270c201ff4cd4b1cc6f1afb85fa59 |
| institution | DOAJ |
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| publishDate | 2025-07-01 |
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| spelling | doaj-art-093270c201ff4cd4b1cc6f1afb85fa592025-08-20T03:05:57ZengBMCBMC Anesthesiology1471-22532025-07-0125111210.1186/s12871-025-03215-7High-altitude adaptation as a protective factor against postoperative pulmonary complications in liver resection: a prospective matched cohort studyQingyong Luo0Yu Zhang1Shiyao Gu2Li liu3Si Zeng4Qian Lei5Department of Anesthesiology, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of ChinaSchool of Medical and Life Sciences, Chengdu University of Traditional Chinese MedicineDepartment of Anesthesiology, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of ChinaSchool of Medical and Life Sciences, Chengdu University of Traditional Chinese MedicineDepartment of Anesthesiology, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of ChinaDepartment of Anesthesiology, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of ChinaAbstract Background High-altitude adaptation (HAA), induced by chronic hypoxia, has clinically significant cardioprotective effects; however, its impact on postoperative pulmonary complications (PPCs) in patients undergoing liver resection remains uncertain. Methods We conducted a single-center prospective matched cohort study enrolling 292 consecutive patients undergoing elective liver resection. Patients were divided into two groups based on their long-term residential altitude: high-altitude group (≥ 1500 m) and plain group (< 1500 m). Propensity score matching (1:2 ratio) was applied to control for confounding factors, including demographic variables, clinical characteristics, preoperative oxygen saturation, ARISCAT score, and surgical factors. The primary outcome was the incidence of PPCs within 7 days after surgery. Secondary outcomes included the severity of PPCs, surgical complication grading, and length of hospital stay. Statistical analysis was performed using R software and SPSS 22.0. Results After matching, 212 patients were included in the analysis. The incidence of PPCs within 7 days postoperatively in the high-altitude group was significantly lower than that in the plain group (61.5% vs. 76.1%, RR 0.80, 95% CI 0.66–0.98, P = 0.024). Furthermore, the high-altitude group showed milder complication severity and a shorter hospital stay (6 [4–8] vs. 7 [5–11] days, P = 0.005). Multivariate logistic regression analysis showed that HAA was an independent protective factor against PPCs (OR 0.31, 95% CI 0.12–0.83, P = 0.020). Further exploratory analysis revealed that during hepatic pedicle clamping, blood glucose levels remained more stable in the high-altitude group ([9.30 [7.25–11.90] vs. 10.95 [7.90–14.00] mmol/L, P < 0.001), with lower lactate accumulation after multiple clamps (1.55 [1.10–2.17] vs. 1.70 [1.10–2.50] mmol/L, P = 0.042). Conclusion HAA may reduce the incidence and severity of PPCs after liver resection, potentially due to enhanced metabolic stability associated with chronic hypoxia in high-altitude residents. Trial registration This study is registered with ChiCTR (ID: ChiCTR2200061915), registered on July 11, 2022.https://doi.org/10.1186/s12871-025-03215-7High-altitude adaptationLiver resection surgeryPostoperative pulmonary complicationsBlood glucoseLactic |
| spellingShingle | Qingyong Luo Yu Zhang Shiyao Gu Li liu Si Zeng Qian Lei High-altitude adaptation as a protective factor against postoperative pulmonary complications in liver resection: a prospective matched cohort study BMC Anesthesiology High-altitude adaptation Liver resection surgery Postoperative pulmonary complications Blood glucose Lactic |
| title | High-altitude adaptation as a protective factor against postoperative pulmonary complications in liver resection: a prospective matched cohort study |
| title_full | High-altitude adaptation as a protective factor against postoperative pulmonary complications in liver resection: a prospective matched cohort study |
| title_fullStr | High-altitude adaptation as a protective factor against postoperative pulmonary complications in liver resection: a prospective matched cohort study |
| title_full_unstemmed | High-altitude adaptation as a protective factor against postoperative pulmonary complications in liver resection: a prospective matched cohort study |
| title_short | High-altitude adaptation as a protective factor against postoperative pulmonary complications in liver resection: a prospective matched cohort study |
| title_sort | high altitude adaptation as a protective factor against postoperative pulmonary complications in liver resection a prospective matched cohort study |
| topic | High-altitude adaptation Liver resection surgery Postoperative pulmonary complications Blood glucose Lactic |
| url | https://doi.org/10.1186/s12871-025-03215-7 |
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