Key result
Intraoperative MAP of 60–65 mmHg is linked to ~50% higher postoperative mortality in noncardiac surgery.
Why the study?
Blood pressure fluctuation is common during non-cardiac surgery in the elderly, but whether intraoperative hypotension and other risk factors relate to postoperative mortality required analysis.
Does an intraoperative MAP between 60 and 65 mmHg increase the risk of postoperative mortality in elderly patients undergoing noncardiac surgery?
Case-Control (n=354)
Yes
Does an intraoperative MAP between 60 and 65 mmHg increase the risk of postoperative mortality in elderly patients undergoing noncardiac surgery?
Odds Ratio: 1.505 (95% CI 1.023–2.215)
p-value: p=0.038
Maintaining an intraoperative mean arterial pressure above 65 mmHg may be necessary to reduce the risk of postoperative mortality in elderly patients undergoing noncardiac surgery.
May warrant higher intraoperative MAP targets in elderly noncardiac surgery; leaves open confirmation via prospective trials.
Background: Blood pressure fluctuation is very common during non-cardiac surgery in elderly. This retrospective study was to analyse whether intraoperative hypotension in elderly and other risk factors relate to the postoperative mortality. Methods: A total of 118 cases (Observational group), who underwent noncardiac surgery in three medical centers between September 2014 and March 2017, and died in the hospital after the noncardiac surgery. With 1:2 ratio of propensity matching, 236 survival cases (Control group) were selected for comparison analyses with the death cases. Intraoperative blood pressure and perioperative parameters from both groups were collected from electronic anaesthesia charts. Data were analysed with univariate logistic regression analysis where variables with p values less than 0.05 were analysed with multivariate logistic regression analysis. The receiver operating characteristic (ROC) curve was constructed. Results: There are five risk factors related to postoperative death in elderly patients: ASA grade, COPD, emergency surgery, general anesthesia, 60 < MAP ≤ 65mmHg (OR > 1), and one factor may reduce the risk of postoperative mortality, which is PACU therapy (OR < 1). Compared with the Control group, the Observational group had a higher proportion of cerebral hernia, kidney injury and trauma ( p < 0.001). The intraoperative blood transfusion volume and intraoperative blood loss volume were higher in the Observational group than the Control group ( p < 0.001). The proportion of using vasoactive drugs was higher in the Observational group ( p < 0.001), and there was more urine output during the operation in the Observational group ( p = 0.005). Conclusion: The intraoperative MAP of geriatric patients lower than 65mmHg is highly related to the postoperative mortality. Elderly patients with emergency surgery, high ASA grade and a history of COPD have an increased risk of postoperative mortality. General anesthesia is a risk factor for postoperative death in elderly patients, and the PACU therapy is a protective factor to avoid postoperative death. Trial Registration: This study has been retrospectively registered in the Chinese Clinical Trials Registry (ChiCTR2000038912, 10/10/2020).
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Zhao et al. (2021) conducted a case-control in Noncardiac surgery in elderly patients (n=354). Intraoperative mean arterial pressure (MAP) between 60 and 65 mmHg vs. Intraoperative MAP > 65 mmHg (or other MAP ranges) was evaluated on Postoperative mortality (in-hospital death within 60 days) (OR 1.505, 95% CI 1.023-2.215, p=0.038). In elderly patients undergoing noncardiac surgery, maintaining an intraoperative mean arterial pressure between 60 and 65 mmHg was independently associated with an increased risk of postoperative mortality (OR 1.505).
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