title: Intraoperative tachycardia and hypertension are independently associated with adverse outcome in noncardiac surgery of long duration.
abstract: Relatively little is known about the influence of intraoperative hemodynamic variables on surgical outcomes. We drew subjects (n = 797) from a study of patients undergoing major noncardiac surgery. The physiological component of the POSSUM (Physiological and Operative Severity Score for the enUmeration of Mortality) operative risk stratification index was determined, and intraoperative measurements of heart rate (HR), mean arterial blood pressure, and systolic arterial blood pressure (SAP) were retrieved from computerized anesthesia records. For every 5-min epoch during the surgery, HR, mean arterial blood pressure, and SAP were each classified as low, normal, or high. Negative surgical outcome (NSO) was defined as a hospital stay of >10 days with a morbid condition or death during the hospital stay. Statistical analyses included Mantel-Haenszel tests and multiple logistic regression. There was no significant association between hemodynamic variables and NSO with short operations. In 388 patients with operations longer than the median time of 220 min, NSO occurred in 15.6%. Controlling for POSSUM score and operation time beyond 220 min, both high HR (odds ratio, 2.704; P = 0.01) and high SAP (odds ratio, 2.095; P = 0.009) were associated with NSO in longer operations. Thus, intraoperative tachycardia and hypertension were associated independently with adverse outcomes after major noncardiac surgery of long duration, over and above the risk imparted by underlying medical conditions.
  
  
  CONCLUSIONS
  Intraoperative tachycardia and hypertension were associated with negative postoperative outcomes after major noncardiac surgery of long duration. These results imply that intraoperative tachycardia and hypertension may have independent effects on outcome over and above the risk imparted by underlying medical conditions.
authors.affiliation: Department of Anesthesiology, Mount Sinai School of Medicine, New York, New York 10029, USA. david.reich@mssm.edu
authors.forename: David L
authors.initials: DL
authors.lastname: Reich
authors.forename: Elliott
authors.initials: E
authors.lastname: Bennett-Guerrero
authors.forename: Carol A
authors.initials: CA
authors.lastname: Bodian
authors.forename: Sabera
authors.initials: S
authors.lastname: Hossain
authors.forename: Wanda
authors.initials: W
authors.lastname: Winfree
authors.forename: Marina
authors.initials: M
authors.lastname: Krol
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001794:Blood Pressure / Q000502:physiology; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000401:mortality; D007431:Intraoperative Complications / Q000401:mortality / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D013514:Surgical Procedures, Operative / Q000009:adverse effects* / Q000401:mortality; D013610:Tachycardia / Q000150:complications* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome