Targeting higher intraoperative blood pressure values during noncardiac surgery did not reduce acute kidney injury (RR 0.95; 95% CI 0.85-1.06; p=0.36) compared with routine management.
Meta-Analysis (n=15,603)
Does targeting higher intraoperative blood pressure values reduce adverse postoperative outcomes in adults undergoing elective noncardiac surgery with general anesthesia?
Targeting higher intraoperative blood pressure during noncardiac surgery does not improve major postoperative outcomes like AKI or myocardial injury compared to routine management, though it may reduce postoperative delirium.
Relative Risk: 0.95 (95% CI 0.85–1.06)
p-value: p=0.36
Background: Observational studies consistently link intraoperative hypotension to adverse postoperative outcomes, leading guidelines to recommend maintaining mean arterial pressure (MAP) ≥60–65 mmHg during noncardiac surgery. Whether targeting higher intraoperative blood pressure values improves clinical outcomes remains uncertain. Methods: We conducted a PRISMA-guided search on PubMed, Cochrane CENTRAL, Scopus, and Embase from inception to April 2026. Randomized trials comparing higher intraoperative blood pressure targets, either as fixed absolute thresholds or personalized to preoperative baseline, versus routine blood pressure management in adults undergoing elective noncardiac surgery with general anesthesia were included. Outcomes included in-hospital or 30-day mortality, postoperative delirium, acute kidney injury (AKI), 30-day major cardiovascular events (MACE), acute myocardial injury, stroke, length of stay, and intraoperative hypotension. Results: Fifteen trials (15,603 patients) were included. Higher targets did not reduce AKI (RR = 0.95; 95% CI = 0.85 to 1.06; p = 0.36; I² = 16%) or acute myocardial injury (RR = 1.02; 95% CI = 0.94 to 1.12; p = 0.59; I² = 0%) compared with routine targets, with firm evidence from trial sequential analysis (TSA). Higher targets were associated with a significant reduction in postoperative delirium (RR = 0.73; 95% CI = 0.54 to 0.98; p = 0.04; I² = 26%), although TSA indicated the cumulative evidence remained insufficient to draw firm conclusions. No significant effect was observed on in-hospital or 30-day mortality (RR = 1.00; 95% CI = 0.75 to 1.34; p = 1.00; I² = 0%); evidence on 30-day MACE, stroke, and length of stay was similarly insufficient to draw firm conclusions. Conclusion: In adults undergoing elective noncardiac surgery, targeting higher intraoperative blood pressure values does not improve major postoperative outcomes compared with routine management. A potential reduction in postoperative delirium warrants confirmation in adequately powered trials.
Chiou et al. (Thu,) conducted a meta-analysis in Elective noncardiac surgery (n=15,603). Higher intraoperative blood pressure targets vs. Routine blood pressure management was evaluated on Acute kidney injury (AKI) (RR 0.95, 95% CI 0.85 to 1.06, p=0.36). Targeting higher intraoperative blood pressure values during noncardiac surgery did not reduce acute kidney injury (RR 0.95; 95% CI 0.85-1.06; p=0.36) compared with routine management.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: