title: Preoperative arterial pulse pressure has no apparent association with perioperative mortality after lower extremity arterial bypass.
abstract: BACKGROUND
  Arterial pulse pressure hypertension is associated with perioperative morbidity and mortality in cardiac surgery patients. However, its association with perioperative mortality in other high-risk surgical populations has not been determined. In this study, we tested the hypothesis that increased preoperative arterial pulse pressure is associated with 30-day and 1-year all-cause mortality after lower extremity arterial bypass surgery.
  
  
  METHODS
  A retrospective review of patients who had infrainguinal arterial bypass surgery at a single center over a 6-year period (January 2002 to January 2008) was performed (n = 556). Mean, systolic, and diastolic arterial blood pressure were determined from a single noninvasive oscillometric blood pressure cuff reading in the operating room before the administration of anesthetic drugs. Pulse pressure was calculated from this measurement in a retrospective manner by subtracting diastolic pressure from systolic pressure. Mortality for all subjects was determined using the social security death index. Comorbid conditions, preoperative medications, and anesthetic techniques were recorded. Univariate and multivariate analyses were performed to evaluate the association between arterial pulse pressure and the primary outcome variables, and all-cause 30-day and 1-year mortality.
  
  
  RESULTS
  Of the 556 patients, a large percentage had elevated pulse pressure (44.9% had pulse pressure ≥80). Thirty-day mortality was 5.1% and 1-year mortality was 17.8%. There was no apparent association between preoperative pulse pressure and 30-day (P = 0.35) or 1-year (P = 0.14) all-cause mortality. Independent predictors of 30-day mortality were age ≥80 years (P = 0.02), ASA physical status ≥IV (P = 0.04), baseline creatinine >2.0 mg/dL (P < 0.0001), and emergency surgery (P = 0.009). The same variables were associated with 1-year mortality, as were the Lee's Revised Cardiac Risk Index score, female gender, and gangrene or ulcer as an indication for surgery.
  
  
  CONCLUSIONS
  Our results suggest that increased preoperative arterial pulse pressure might not be associated with all-cause mortality after lower extremity arterial bypass surgery.
authors.affiliation: Department of Anesthesiology, Mount Sinai School of Medicine, New York, NY 10029, USA. michael.mazzeffi@Mountsinai.org
authors.forename: Michael
authors.initials: M
authors.lastname: Mazzeffi
authors.forename: Brigid
authors.initials: B
authors.lastname: Flynn
authors.forename: Carol
authors.initials: C
authors.lastname: Bodian
authors.forename: David
authors.initials: D
authors.lastname: Bronheim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries / Q000503:physiopathology / Q000601:surgery; D001794:Blood Pressure; D016009:Chi-Square Distribution; D015897:Comorbidity; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000401:mortality* / Q000503:physiopathology; D016014:Linear Models; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D009519:New York City; D017711:Nonlinear Dynamics; D059035:Perioperative Period; D058729:Peripheral Arterial Disease / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality*