Inhalation Anaesthesia Compared with Total Intravenous Anaesthesia and Postoperative Complications in Colorectal Cancer Surgery: An Observational Registry-Based Study.

Hasselager, R.P., Hallas, J. and Gögenur, I

British Journal of Anaesthesia 2022; 129 (3): 416-26. DOI:

Aim of Study

  • To investigate whether there is an association between the type of anaesthesia (inhalational vs total intravenous) and risk of post-operative complications after colorectal cancer surgery

Design and Location

  • Denmark; observational study


  • Patient selection: Danish national registries of patients undergoing colorectal cancer surgery from 2004 to 2018 (Total number of patients: 22, 179 included 40.9% of total eligible)
  • Known potential confounders accounted for by using a propensity score matching approach
  • 8722 in each group (TIVA vs inhaled volatile anaesthesia)


Primary Outcome

  • Any complications within 30 days postoperatively

Secondary Outcomes

  • Any surgical complications within 30 days postoperatively
  • Any medical complications within 30 days postoperatively
  • 30-day mortality 



  • Pre-data collection analysis done: 2,402 individuals required as a minimum in each group to detect a 20% relative difference between groups (if postoperative complications rate is around 15% and significance set to 0.05 with study powered to 80%)
  • Effect estimates for outcomes computed by using logistic regression and presented as odds ratio with 95% CIs



  • Fewer total post-operative complications occurred in the inhaled anaesthesia cohort – OR 0.84 (0.79-0.91)
  • Fewer surgical complications occurred in the inhaled anaesthesia cohort – OR 0.76 (0.71-0.83)
  • No difference in medical complications


  • Inhalational anaesthesia associated with fewer complications than TIVA for colorectal cancer surgery
  • Hypothesis generated. Further randomised controlled study required to ascertain causality.

Limitations from the Study

  • Propensity scoring does not address unmeasurable or unknown confounders
  • Statistically significant does not exclude the possibility that results occurred due to chance
  • Can only draw an association from an observational study not causation
  • Structure of care probably matters more than the exact details of care

Summary by Dr P Nalwaya. Journal Club Meeting 13 October 2022.

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