title: Influence of intraoperative hypotension on leaks after sleeve gastrectomy.
abstract: BACKGROUND
  Leak after a sleeve gastrectomy (SG) is a severe complication. Risk factors, such as regional ischemia, increased intraluminal pressure, technical failure of the stapling device, and surgeon error, have been reported.
  
  
  OBJECTIVE
  It was hypothesized that intraoperative hypotension is another risk factor for leak, similar to that reported for colorectal surgery.
  
  
  METHODS
  Tertiary teaching hospital in The Netherlands.
  
  
  METHODS
  Results of a 7-year cohort of primary SGs were reviewed in relation to multiple intraoperative blood pressure measurements. The thresholds for the mean pressure were 40 to 70 mm Hg and for the systolic pressure 70 to 100 mm Hg. Only continuous episodes of 15 and 20 minutes were included.
  
  
  RESULTS
  Twenty-four leaks were identified in a cohort of 1041 primary SGs. Episodes of systolic blood pressure<100 mm Hg for 15 min (P = .027) and 20 minutes (P = .008) were significantly related to a staple line leak. An episode of mean blood pressure<70 mm Hg for 20 min was significantly related to leak (P = .014). Episodes with lower thresholds of pressure occurred less frequently and revealed no significant differences. Other identified risk factors were smoking (P = .019), fast-track recovery program (P = .006), use of a tri-stapler (P = .004), and duration of surgery (P = .000). In a multivariate analysis, only intraoperative systolic pressure<100 mm Hg for 20 minutes remained significant (odds ratio, 2.45; P = .012).
  
  
  CONCLUSIONS
  Intraoperative hypotension may contribute independently to a leak after SG.
authors.affiliation: Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands. Electronic address: simon.nienhuijs@cze.nl.
authors.forename: Simon W
authors.initials: SW
authors.lastname: Nienhuijs
authors.affiliation: Faculty of Industrial Engineering & Innovation Sciences (IE&IS), Eindhoven University of Technology, Eindhoven, The Netherlands.
authors.forename: Uzay
authors.initials: U
authors.lastname: Kaymak
authors.affiliation: Department of Anesthesiology, Catharina Hospital, Eindhoven, The Netherlands.
authors.forename: Erik
authors.initials: E
authors.lastname: Korsten
authors.affiliation: Department of Anesthesiology, Catharina Hospital, Eindhoven, The Netherlands.
authors.forename: Marc P
authors.initials: MP
authors.lastname: Buise
mesh_terms: D050110:Bariatric Surgery / Q000009:adverse effects / Q000379:methods; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D007022:Hypotension / Q000209:etiology*; D007431:Intraoperative Complications / Q000209:etiology*; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D061646:Operative Time; D017792:Surgical Stapling / Q000009:adverse effects; D013529:Surgical Wound Dehiscence / Q000209:etiology*
keywords: Intraoperative hypotension; Leak; Sleeve gastrectomy