High Intraoperative Pulse Pressure Is A Risk Factor For A Postoperative Organ Injury In A Cohort of Abdominal Surgery Patients: An Exploratory Study

Background: Both intraoperative hypotension and hypertension have been reported to increase the occurrence of either acute kidney injury (AKI), myocardial infraction (MI) or stroke. However, intraoperative pulse pressure’s (PP) impact on the latter complications remains relatively unknown. Methods: This is a cohort study in which patients who underwent abdominal surgery between 1 October 2018 and 15 July 2019 in university hospital in Katowice were included in the analysis. Pre- and intraoperative data, including blood pressure measurements, were acquired via medical charts. Several PP thresholds were applied: >50, >55, >60, >65, >70, >75, >80, >85, >90 mmHg. Additionally, by analysing the maximal PP during procedures, a cut-off point for the occurrence of outcomes was estimated. Postoperative complications were defined as occurrence of either AKI, MI or stroke. Univariable and multivariable analyses were performed to assess PP’s relationship with hypoperfusive organ injury. Results: 508 patients were included in the analysis. Hypoperfusion was present in 38 (7.5%) cases. ROC curve analysis estimated a cut-off point of > 74 mmHg of maximal PP to be associated with the outcomes. PP values above 65 mmHg onward were included in the multivariable statistical models. A model in which PP > 90 mmHg (OR=4.21; 95%CI 1.73-10.24; p=0.0015) was included, had the best predicting value in predicting hypoperfusive injury. Apart of PP, intraoperative hypotension, presence of chronic arterial hypertension and procedure duration were independently associated with postoperative complications. Conclusions: High intraoperative pulse pressure may be associated with the occurrence of hypoperfusion-related organ injury. However, the effect of high pulse pressure should be confirmed in other non-cardiac populations to prove generalizability of our results.