Key result
Extended durations of intraoperative mean arterial pressure below 70 mmHg were associated with the development of acute kidney injury, myocardial infarction, or stroke.
Why the study?
Most data linking intraoperative hypotension to adverse outcomes come from heterogeneous cohorts, leaving its predictive value unclear in homogenous cohorts undergoing abdominal surgery under general anaesthesia.
Do various thresholds and durations of intraoperative hypotension predict clinically significant hypoperfusion in patients undergoing abdominal surgery?
Cohort (n=508)
No
Do various thresholds and durations of intraoperative hypotension predict clinically significant hypoperfusion in patients undergoing abdominal surgery?
Absolute intraoperative mean arterial pressure thresholds below 70 mmHg, rather than relative drops from baseline, are associated with an increased risk of perioperative myocardial injury, AKI, or stroke in abdominal surgery.
May encourage intraoperative BP optimization; leaves open causality and practice change pending RCTs.
The recent consensus by the Perioperative Quality Initiative (POQI) on intraoperative hypotension (IOH) stated that mean arterial pressure (MAP) below 60-70 mmHg is associated with myocardial infarction (MI), acute kidney injury (AKI), death and also that IOH is a function of not only severity but also of duration. However, most of the data come from large, heterogeneous cohorts of patients who underwent different surgical procedures and types of anaesthesia. We sought to assess how various definitions of IOH can predict clinically significant hypoperfusive outcomes in a homogenous cohort of generally anesthetised patients undergoing abdominal surgery, taking into account thresholds of MAP and their time durations. The data for this study come from a prospective cohort study in which patients who underwent abdominal surgery between 1 October 2018 and 15 July 2019 in the university hospital in Katowice were included in the analysis. We analysed perioperative data to assess how various IOH thresholds can predict hypoperfusive outcomes (defined as myocardial injury, acute kidney injury or stroke). 508 patients were included in the study. The total number of cases of clinically significant hypoperfusion was 38 (7.5%). We found that extending durations of low MAP, i.e., below 55 mmHg, 60 mmHg, 65 mmHg and 70 mmHg, were associated with the development of either AKI, MI or stroke. It was observed that for narrower and lower hypotension thresholds, the time required to induce complications is shorter. Patients who suffered from AKI/MI/Stroke experienced more episodes of any of the IOH definitions applied. Absolute IOH thresholds were superior to the relative definitions. For patients undergoing abdominal surgery, it is vital to prevent the extended durations of intraoperative mean arterial pressure below 70 mmHg. Finally, there appears to be no need to guide intraoperative haemodynamic therapy based on pre-induction values and, consequently, on relative drops of MAP.
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Putowski et al. (2021) conducted a cohort in Abdominal surgery (n=508). Intraoperative hypotension (MAP <70 mmHg) was evaluated on Clinically significant hypoperfusion (myocardial injury, acute kidney injury, or stroke). Extended durations of intraoperative mean arterial pressure below 70 mmHg were associated with the development of acute kidney injury, myocardial infarction, or stroke.
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