Cumulative deep hypnotic time (RR 1.244/h; P=0.0121) and intraoperative systolic hypotension (RR 1.036/min; P=0.0125) independently predicted 1-year mortality after major noncardiac surgery.
Observational (n=1,064)
Are intraoperative anesthetic management variables (deep hypnotic time and hypotension) associated with one-year mortality in adult patients undergoing major noncardiac surgery?
Intraoperative hypotension and prolonged cumulative deep hypnotic time during noncardiac surgery are significant independent predictors of one-year mortality, suggesting anesthetic management affects long-term outcomes.
Effect estimate: RR 1.244/h
p-value: p=0.0121
In Brief Little is known about the effect of anesthetic management on long-term outcomes. We designed a prospective observational study of adult patients undergoing major noncardiac surgery with general anesthesia to determine if mortality in the first year after surgery is associated with demographic, preoperative clinical, surgical, or intraoperative variables. One-year mortality was 5.5% in all patients (n = 1064) and 10.3% in patients ≥65 yr old (n = 243). Multivariate Cox Proportional Hazards modeling identified three variables as significant independent predictors of mortality: patient comorbidity (relative risk, 16.116; P < 0.0001), cumulative deep hypnotic time (Bispectral Index® <45) (relative risk = 1.244/h; P = 0.0121) and intraoperative systolic hypotension (relative risk = 1.036/min; P = 0.0125). Death during the first year after surgery is primarily associated with the natural history of preexisting conditions. However, cumulative deep hypnotic time and intraoperative hypotension were also significant, independent predictors of increased mortality. These associations suggest that intraoperative anesthetic management may affect outcomes over longer time periods than previously appreciated. IMPLICATIONS: A prospective, longitudinal study of 1-yr postoperative mortality after noncardiac surgery confirms that comorbidity is the primary predictor and that intraoperative hypotension and prolonged cumulative deep hypnotic time are also significant risk factors. Intraoperative anesthetic management may have a greater effect on long-term outcomes than previously appreciated.
Monk et al. (2004) conducted an observational in major noncardiac surgery (n=1,064). Cumulative deep hypnotic time and intraoperative systolic hypotension was evaluated on One-year mortality (RR 1.244/h, p=0.0121). Cumulative deep hypnotic time (RR 1.244/h; P=0.0121) and intraoperative systolic hypotension (RR 1.036/min; P=0.0125) independently predicted 1-year mortality after major noncardiac surgery.