Intraoperative hypotension and 1-year mortality after noncardiac surgery.
BACKGROUND
Intraoperative hypotension (IOH) is frequently associated with adverse outcome such as 1-yr mortality. However, there is no consensus on the correct definition of IOH. The authors studied a number of different definitions of IOH, based on blood pressure thresholds and minimal episode durations, and their association with 1-yr mortality after noncardiac surgery.


METHODS
This cohort study included 1,705 consecutive adult patients who underwent general and vascular surgery. Data on IOH and potentially confounding variables were obtained from electronic record-keeping systems. Mortality data were collected up to 1 yr after surgery. The authors used two different techniques to reduce the influence of confounding variables, multivariable Cox proportional hazard regression modeling and classification and regression tree analysis.


RESULTS
The mortality within 1 yr after surgery was 5.2% (88 patients). After adjustment for confounding, the Cox regression analysis did not show an association between IOH and the risk of dying within 1 yr after surgery (hazard ratio around 1.00 with high P values for different definitions of IOH). Additional classification and regression tree analysis identified IOH as a predictor for 1-yr mortality in elderly patients. When the blood pressure threshold for IOH was decreased, the duration of IOH at which this association was found was decreased as well.


CONCLUSIONS
This observational study showed no causal relation between IOH and 1-yr mortality after noncardiac surgery for any of the definitions of IOH. Nevertheless, additional analysis suggested that for elderly patients, the mortality risk increases when the duration of IOH becomes long enough. The length of this duration depends on the designated blood pressure threshold, suggesting that lower blood pressures are tolerated for shorter durations. The effect of IOH on 1-yr mortality remains debatable, and no firm conclusions on the lowest acceptable intraoperative blood pressures can be drawn from this study.
Bijker
Jilles B
JB
Division of Perioperative Care and Emergency Medicine, Department of Anesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands. j.b.bijker@umcutrecht.nl
van Klei
Wilton A
WA
Vergouwe
Yvonne
Y
Eleveld
Douglas J
DJ
van Wolfswinkel
Leo
L
Moons
Karel G M
KG
Kalkman
Cor J
CJ
D000758:Anesthesia; D019540:Area Under Curve; D015992:Body Mass Index; D002423:Cause of Death; D015331:Cohort Studies; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D007022:Hypotension / Q000401:mortality*; D007431:Intraoperative Complications / Q000503:physiopathology*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D016016:Proportional Hazards Models; D012044:Regression Analysis; D013514:Surgical Procedures, Operative; D016019:Survival Analysis; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures