Effects of intraoperative hemodynamic instability on postoperative adverse outcomes in patients with cardiovascular comorbidities undergoing noncardiac surgery − an observational study

Background and aims Cardiovascular diseases, especially coronary artery disease, have become an epidemic in India. There are a significant number of asymptomatic cases that are not diagnosed until an invasive intervention is required. The presence of such cardiac comorbidities may in turn lead to intraoperative hemodynamic changes in patients undergoing noncardiac surgery under general or regional anesthesia. This prospective observational study was designed to register and compare the incidence of intraoperative cardiovascular events of variation in heart rate and blood pressure in relation to postoperative adverse outcomes in patients with cardiac comorbidities undergoing noncardiac surgery. The statistical analysis was performed by SPSS 23.0 version. Patients and methods A total of 200 patients of American Society of Anesthesiologists grades II, III, and IV having known cardiovascular comorbidities posted for elective noncardiac surgical procedures under general/regional anesthesia were closely monitored for any intraoperative hemodynamic disturbances, namely, variations in heart rate and blood pressure. After the completion of surgery, the patients were followed up during the immediate postoperative period for up to 72 h for documenting any postoperative adverse outcomes. Results In this study, preexisting hypertensive heart disease and intraoperative hypotension emerged as independent predictors for postoperative adverse outcomes, whereas the most common postoperative adverse outcome was acute kidney injury. Conclusion Meticulous risk stratification of patients preoperatively may help guide decisions on adequate perioperative management, thus reducing untoward adverse events.