Association of esketamine with acute lung injury and macrophage polarization-related markers after ATAAD surgery
- 1Department of Anesthesiology, Shandong Provincial Third Hospital, Shandong University, No. 11 Wuyingshan Middle Road, Tianqiao District, Jinan City, 250031 Shandong Province People’s Republic of China
Abstract
Objective: To investigate the association between perioperative esketamine use, postoperative acute lung injury (ALI), and macrophage polarization-related markers in patients undergoing acute type A aortic dissection (ATAAD) surgery.
Methods: A total of 124 patients with ATAAD treated at our hospital between January 2022 and December 2024 were retrospectively included. Postoperative ALI was assessed within the first 24 h after ICU admission following ATAAD surgery, and patients were classified into the ALI group (n = 52) and non-ALI group (n = 72) accordingly. Univariate analysis and binary logistic regression were performed to identify factors associated with postoperative ALI after ATAAD surgery. Patients were further analyzed according to perioperative esketamine use to evaluate differences in macrophage polarization-related markers and clinical outcomes.
Results: Binary logistic regression analysis showed that hypertension was independently associated with an increased risk of postoperative ALI (OR = 5.586, 95% CI: 1.832–17.034, P = 0.002), whereas perioperative esketamine use was independently associated with a reduced risk of postoperative ALI (OR = 0.155, 95% CI: 0.061–0.394, P < 0.001). After propensity score matching, 45 matched pairs were retained. In the matched cohort, postoperative ALI occurred in 11 patients in the esketamine group and 23 patients in the non-esketamine group (24.4% vs. 51.1%, P = 0.011). Perioperative esketamine use remained associated with a lower risk of postoperative ALI after matching (OR = 0.31, 95% CI: 0.13–0.74, P = 0.008). Patients in the esketamine group also showed a lower postoperative M1-related index and M1/M2 ratio, a higher M2-related index, and a shorter hospital stay.
Conclusion: Perioperative esketamine use was associated with a lower risk of postoperative ALI after ATAAD surgery and was accompanied by favorable changes in macrophage polarization-related markers. Given the retrospective single-center design and limited sample size, these findings should be interpreted cautiously and require validation in larger prospective studies.
Trial registration: Not applicable. This was a retrospective observational study and did not involve prospective assignment of participants to an intervention.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12893-026-04047-z.
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BibTeX
@article{cui2026association,
title = {{Association of esketamine with acute lung injury and macrophage polarization-related markers after ATAAD surgery}},
author = {Xiangqian Cui and Peng Jiang and Xianhu Li and Hexi Hou},
journal = {BMC Surgery},
year = {2026},
month = jul,
doi = {10.1186/s12893-026-04047-z},
url = {https://doi.org/10.1186/s12893-026-04047-z},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Association of esketamine with acute lung injury and macrophage polarization-related markers after ATAAD surgery
AU - Xiangqian Cui
AU - Peng Jiang
AU - Xianhu Li
AU - Hexi Hou
PY - 2026
DA - 2026/07/31
JO - BMC Surgery
DO - 10.1186/s12893-026-04047-z
UR - https://doi.org/10.1186/s12893-026-04047-z
AB - Objective: To investigate the association between perioperative esketamine use, postoperative acute lung injury (ALI), and macrophage polarization-related markers in patients undergoing acute type A aortic dissection (ATAAD) surgery. Methods: A total of 124 patients with ATAAD treated at our hospital between January 2022 and December 2024 were retrospectively included. Postoperative ALI was assessed within the first 24 h after ICU admission following ATAAD surgery, and patients were classified into the ALI group (n = 52) and non-ALI group (n = 72) accordingly. Univariate analysis and binary logistic regression were performed to identify factors associated with postoperative ALI after ATAAD surgery. Patients were further analyzed according to perioperative esketamine use to evaluate differences in macrophage polarization-related markers and clinical outcomes. Results: Binary logistic regression analysis showed that hypertension was independently associated with an increased risk of postoperative ALI (OR = 5.586, 95% CI: 1.832–17.034, P = 0.002), whereas perioperative esketamine use was independently associated with a reduced risk of postoperative ALI (OR = 0.155, 95% CI: 0.061–0.394, P < 0.001). After propensity score matching, 45 matched pairs were retained. In the matched cohort, postoperative ALI occurred in 11 patients in the esketamine group and 23 patients in the non-esketamine group (24.4% vs. 51.1%, P = 0.011). Perioperative esketamine use remained associated with a lower risk of postoperative ALI after matching (OR = 0.31, 95% CI: 0.13–0.74, P = 0.008). Patients in the esketamine group also showed a lower postoperative M1-related index and M1/M2 ratio, a higher M2-related index, and a shorter hospital stay. Conclusion: Perioperative esketamine use was associated with a lower risk of postoperative ALI after ATAAD surgery and was accompanied by favorable changes in macrophage polarization-related markers. Given the retrospective single-center design and limited sample size, these findings should be interpreted cautiously and require validation in larger prospective studies. Trial registration: Not applicable. This was a retrospective observational study and did not involve prospective assignment of participants to an intervention. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12893-026-04047-z.
SN - 1471-2482
ER -