Key result
Intraoperative hypotension is associated with acute kidney injury and myocardial ischemia, but evidence regarding its association with cerebral ischemia and postoperative delirium remains inconsistent.
Why the study?
The reported incidence of intraoperative hypotension varies widely, and its association with different postoperative outcomes required evaluation across published literature.
Does intraoperative hypotension increase the risk of acute kidney injury, myocardial injury, cerebral ischemia, and postoperative delirium in patients undergoing non-cardiac surgery?
Does intraoperative hypotension increase the risk of acute kidney injury, myocardial injury, cerebral ischemia, and postoperative delirium in patients undergoing non-cardiac surgery?
Intraoperative hypotension during non-cardiac surgery is associated with increased risks of acute kidney injury and myocardial injury, highlighting the need for careful blood pressure management.
IOH is associated with postoperative AKI, myocardial injury, cerebral ischemia, and delirium; leaves open whether prevention improves outcomes.
Background: The incidence of IOH varies between 5% and 99%, depending on which definition is used. There have been numerous reports on the association between IOH and different postoperative outcomes. Objective: The goal of this study was to evaluate the association between intraoperative hypotension (IOH) and common postoperative outcomes, namely acute kidney injury, myocardial injury, cerebral ischemia, and postoperative delirium. Methods: For this review, we developed a search strategy and searched all relevant medical databases. We searched for cohorts focusing on IOH and the different postoperative outcomes conducted in the past ten years. Eventually we were able to include 16 articles. Results: Regarding acute kidney injury (AKI), there is sufficient high-quality evident that IOH is an independent risk factor for developing AKI. We identified three studies evaluating the association between IOH and myocardial injury. They found a high incidence of myocardial injury, up to 30%. Furthermore, we found an independent association between IOH and myocardial injury. Regarding cerebral ischemia, we identified four cohorts. For now, there has not been a consensus regarding the association between IOH and cerebral ischemia. A few, but not all,studies find an association between IOH and cerebral ischemia. Conflicting evidence regarding a possible association between IOH and postoperative delirium was found. Discussion and conclusion: There seems to be enough evidence that episodes of IOH might be associated with both AKI and myocardial ischemia. The data regarding IOH and cerebral ischemia and POD however are inconsistent. There is a lot of variety between studies regarding the definition of IOH as the study population, so no hard conclusion can be drawn from this review.
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Vossen et al. (2022) conducted a review in Non-cardiac surgery. Intraoperative hypotension vs. No intraoperative hypotension was evaluated on Postoperative complications (acute kidney injury, myocardial injury, cerebral ischemia, and postoperative delirium). Intraoperative hypotension is associated with acute kidney injury and myocardial ischemia, but evidence regarding its association with cerebral ischemia and postoperative delirium remains inconsistent.
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