Relationship between Intraoperative hypotension and clinical outcomes: A multicenter retrospective study

Background Intraoperative hypotension (IOH) is common during pancreatic surgery. This study investigates whether IOH is associated with long-term prognosis in Pancreatic ductal adenocarcinoma (PDAC) patients. Methods This multicenter study enrolled patients who underwent pancreatectomy for PDAC at five Chinese institutions (2017-2023). Using mean arterial pressure (MAP) <70 mmHg for >10 minutes as cutoff, patients were divided into IOH absent and IOH present groups. Overall survival (OS) and recurrence-free survival (RFS) were compared. Cox regression analyses identified independent predictors. Results Of the 443 patients, 101 (22.8%) had an intraoperative blood pressure of less than 70 mmHg for more than 10 minutes. The 1-, 3- and 5- year OS and RFS rates of patients in the IOH present group were 59.4 %, 22.8 %, and 18.8 %, and 36.6 %, 13.9 %, and 12.9 %, respectively. These rates were significantly poorer than those in the IOH absent group (75.4%, 39.8%, and 33.3%, and 50.6 %, 26.6 %, and 24.9 %, respectively; both P < 0.001). Multivariable Cox-regression analyses revealed that MAP below 70 mmHg for more than 10 minutes was an independent predictor of OS (hazard ratio (HR), 1.354; 95% confidence interval (CI): 1.030 -1.779; P = 0.030) and RFS (HR, 1.338; 95% CI: 1.032-1.733; P = 0.028). Conclusions MAP less than 70 mmHg for a duration of more than 10 minutes, was independently associated with OS and RFS after pancreatic surgery for PDAC.