What does this research mean for the field?

Intraoperative hypotension during non-cardiac surgery is associated with an increased risk of severe postoperative complications, including 30-day mortality, acute kidney injury, stroke, myocardial injury, myocardial infarction, and postoperative delirium. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

May 1, 2023HeliyonOpen Access

Association of intraoperative hypotension and severe postoperative complications during non-cardiac surgery in adult patients: A systematic review and meta-analysis

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Why the study?

Intraoperative hypotension is common during non-cardiac surgery and may induce poor outcomes, but its relationship with severe postoperative complications remains unclear.

Does intraoperative hypotension increase the risk of severe postoperative complications in adult patients undergoing non-cardiac surgery?

Structured PICO

Does intraoperative hypotension increase the risk of severe postoperative complications in adult patients undergoing non-cardiac surgery?

Population

Adult patients undergoing non-cardiac surgery (72 studies included: 3 randomized, 69 non-randomized)

Intervention

Intraoperative hypotension (IOH)

Comparator

Non-intraoperative hypotension (non-IOH)

Outcome

30-day mortality, acute kidney injury (AKI), major adverse cardiac events (myocardial injury or myocardial infarction), postoperative cognitive dysfunction (POCD), and postoperative delirium (POD)hard clinical

Intraoperative hypotension during non-cardiac surgery is associated with significantly increased risks of 30-day mortality, acute kidney injury, myocardial injury/infarction, and stroke.

Implication

May warrant closer intraoperative BP monitoring in non-cardiac surgery; leaves open whether targeted interventions reduce these risks.

Abstract

Background: Intraoperative hypotension (IOH) is a common side effect of non-cardiac surgery that might induce poor postoperative outcomes. The relationship between the IOH and severe postoperative complications is still unclear. Thus, we summarized the existing literature to evaluate whether IOH contributes to developing severe postoperative complications during non-cardiac surgery. Methods: We conducted a comprehensive search of PubMed, Embase, Cochrane Library, Web of Science, and the CBM from inception to 15 September 2022. The primary outcomes were 30-day mortality, acute kidney injury (AKI), major adverse cardiac events (myocardial injury or myocardial infarction), postoperative cognitive dysfunction (POCD), and postoperative delirium (POD). Secondary outcomes included surgical-site infection (SSI), stroke, and 1-year mortality. Results: 72 studies (3 randomized; 69 non-randomized) were included in this study. Low-quality evidence showed IOH resulted in an increased risk of 30-day mortality (OR, 1.85; 95% CI, 1.30-2.64; P < .001), AKI (OR, 2.69; 95% CI, 2.15-3.37; P < .001), and stroke (OR, 1.33; 95% CI, 1.21-1.46; P < .001) after non-cardiac surgery than non-IOH. Very low-quality evidence showed IOH was associated with a higher risk of myocardial injury (OR, 2.00; 95% CI, 1.17-3.43; P = .01), myocardial infarction (OR, 2.11; 95% CI, 1.41-3.16; P < .001), and POD (OR, 2.27; 95% CI, 1.53-3.38; P < .001). Very low-quality evidence showed IOH have a similar incidence of POCD (OR, 2.82; 95% CI, 0.83-9.50; P = .10) and 1-year-mortality (OR, 1.66; 95% CI, 0.65-4.20; P = .29) compared with non-IOH in non-cardiac surgery. Conclusion: Our results suggest IOH was associated with an increased risk of severe postoperative complications after non-cardiac surgery than non-IOH. IOH is a potentially avoidable hazard that should be closely monitored during non-cardiac surgery.