TY - JOUR
T1 - Association between propofol dose and 1-year mortality in patients with or without a diagnosis of solid cancer
AU - Schaefer, Maximilian S.
AU - Raub, Dana
AU - Xu, Xinling
AU - Shay, Denys
AU - Teja, Bijan
AU - Chhangani, Khushi
AU - Grabitz, Stephanie D.
AU - O'Gara, Brian
AU - Kienbaum, Peter
AU - Houle, Timothy T.
AU - Landoni, Giovanni
AU - Eikermann, Matthias
N1 - Publisher Copyright:
© 2019 British Journal of Anaesthesia
PY - 2020/3
Y1 - 2020/3
N2 - Background: Preclinical data suggest suppression of cancer proliferation by propofol, and retrospective studies suggest improved survival after cancer surgery with propofol-based anaesthesia. Methods: To determine whether propofol dose administered for anaesthesia is associated with 1-yr mortality in patients with and without a diagnosis of solid cancer, we analysed adult patients undergoing monitored anaesthesia care or general anaesthesia at two academic medical centres in Boston, MA, USA. Logistic regression with interaction term analysis was applied with propofol dose (mg kg−1) as primary and diagnosis of solid cancer as co-primary exposure, and 1-yr mortality as the primary outcome. Results: Of 280 081 patient cases, 10 744 (3.8%) died within 1 yr. Increasing propofol dose was associated with reduced odds of 1-yr mortality (adjusted odds ratio [aOR] 0.93 per 10 mg kg−1; 95% confidence interval [CI]: 0.89–0.98; absolute risk reduction fifth vs first quintile 0.5%; 95% CI: 0.2–0.7). This association was modified by a diagnosis of solid cancer (P<0.001 for interaction). Increasing propofol dose was associated with reduced odds of 1-yr mortality in patients without solid cancer (aOR: 0.78; 95% CI: 0.71–0.85), but not in patients with solid cancer (0.99; 0.94–1.04), a finding that was replicated when examining 5-yr mortality. Conclusions: Increasing propofol dose is associated with lower 1-yr mortality in patients without, but not in patients with, a diagnosis of solid cancer. We found evidence for competing effects, modifying the association between propofol dose and mortality.
AB - Background: Preclinical data suggest suppression of cancer proliferation by propofol, and retrospective studies suggest improved survival after cancer surgery with propofol-based anaesthesia. Methods: To determine whether propofol dose administered for anaesthesia is associated with 1-yr mortality in patients with and without a diagnosis of solid cancer, we analysed adult patients undergoing monitored anaesthesia care or general anaesthesia at two academic medical centres in Boston, MA, USA. Logistic regression with interaction term analysis was applied with propofol dose (mg kg−1) as primary and diagnosis of solid cancer as co-primary exposure, and 1-yr mortality as the primary outcome. Results: Of 280 081 patient cases, 10 744 (3.8%) died within 1 yr. Increasing propofol dose was associated with reduced odds of 1-yr mortality (adjusted odds ratio [aOR] 0.93 per 10 mg kg−1; 95% confidence interval [CI]: 0.89–0.98; absolute risk reduction fifth vs first quintile 0.5%; 95% CI: 0.2–0.7). This association was modified by a diagnosis of solid cancer (P<0.001 for interaction). Increasing propofol dose was associated with reduced odds of 1-yr mortality in patients without solid cancer (aOR: 0.78; 95% CI: 0.71–0.85), but not in patients with solid cancer (0.99; 0.94–1.04), a finding that was replicated when examining 5-yr mortality. Conclusions: Increasing propofol dose is associated with lower 1-yr mortality in patients without, but not in patients with, a diagnosis of solid cancer. We found evidence for competing effects, modifying the association between propofol dose and mortality.
KW - cancer
KW - electronic medical record
KW - general anaesthesia
KW - mortality
KW - propofol
KW - retrospective analysis
KW - risk reduction behaviour
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U2 - 10.1016/j.bja.2019.11.028
DO - 10.1016/j.bja.2019.11.028
M3 - Article
C2 - 31902588
AN - SCOPUS:85077322881
SN - 0007-0912
VL - 124
SP - 271
EP - 280
JO - British Journal of Anaesthesia
JF - British Journal of Anaesthesia
IS - 3
ER -