Intraoperative haemodynamic support intensity as a marker of perioperative complexity and hospital resource utilization in noncardiac surgery

INTRODUCTION: The intensity of intraoperative hemodynamic support may reflect perioperative physiological complexity and be associated with increased hospital resource utilization. OBJECTIVE: To evaluate the use of intraoperative hemodynamic support and the intensity of such support as markers of perioperative complexity and hospital resource utilization. MATERIALS AND METHODS: Analytical study using a secondary database with perioperative information from patients undergoing noncardiac surgery (n = 6,246). The main exposure was intraoperative hemodynamic support, analyzed both dichotomously and through a continuous index of intraoperative hemodynamic support intensity. Outcomes included admission to the intensive care unit (ICU) and hospital length of stay. Multivariable logistic and negative binomial regression models were used, adjusted for relevant clinical and surgical variables, including interaction analyses. RESULTS: Intraoperative hemodynamic support was not independently associated with ICU admission (OR 1.09; 95% CI: 0.93-1.28). In contrast, ASA score (OR 2.89 per point), surgical duration, age, and emergency surgery showed significant associations. Intraoperative hemodynamic support was associated with a longer hospital length of stay (IRR 1.06; 95% CI: 1.02-1.09), an effect that was more pronounced in prolonged procedures. The continuous index of intraoperative hemodynamic support intensity showed a strong association with longer hospital stays (IRR 1.37; 95% CI: 1.34-1.40). CONCLUSIONS: Greater intraoperative hemodynamic support intensity was associated with longer hospital length of stay, particularly in prolonged surgeries, serving as a marker of perioperative complexity and hospital resource utilization.