Key result
Higher intraoperative MAP targets fail to improve postoperative recovery over standard targets in frail arthroplasty patients.
Why the study?
Frailty increases vulnerability to stressors and reduces recovery capacity in elderly patients undergoing anesthesia and surgery, necessitating evaluation of intraoperative blood pressure management.
Does targeting a higher intraoperative MAP (85-100 mmHg) improve the Quality of Recovery-15 score on postoperative day 1 in frail elderly patients undergoing total knee arthroplasty compared to a lower MAP (65-85 mmHg)?
RCT (n=142)
Single-blind
1:1 (computer-generated blocks)
No
Does targeting a higher intraoperative MAP (85-100 mmHg) improve the Quality of Recovery-15 score on postoperative day 1 in frail elderly patients undergoing total knee arthroplasty compared to a lower MAP (65-85 mmHg)?
Mean Difference: 0.91 (95% CI -3.08–4.91)
Absolute Event Rate: 99% vs 98%
p-value: p=0.652
Maintaining a higher intraoperative MAP (85-100 mmHg) does not significantly improve the quality of postoperative recovery on day 1 in frail elderly patients undergoing knee arthroplasty compared to a lower MAP (65-85 mmHg).
No benefit of higher vs lower intraoperative MAP on early recovery after frail TKA; leaves open optimal BP targets in this population.
Background: Frailty is a clinical syndrome characterized by a reduction in the functional capacity of multiple physiological systems, which increases the body's vulnerability to stressors and reduces the capacity of elderly patients to recover from stressful events such as anesthesia and surgery. Methods: A total of 142 elderly frailty patients scheduled for total knee arthroplasty were randomly assigned to either the low-level (Group L) or high-level group (Group H). Group L maintained intraoperative mean arterial pressure (MAP) at 65-85 mmHg, while Group H targeted 85-100 mmHg. The primary outcome was the Quality of Recovery-15 (QoR-15) score on postoperative day (POD) 1. Secondary outcomes include the time-weighted average mean arterial pressure (TWA-MAP) intraoperatively, QoR-15 scores on POD2-5, the abbreviated mental test score (AMTS) at 30 days and 1-year postoperatively, the incidence of myocardial injury after noncardiac surgery (MINS) and acute kidney injury (AKI), 1-year mortality postoperatively. Results: There was no significant difference in QoR-15 values on POD1 between Group L and Group H (mean [SD] 99 [9.89] vs 98 [12.82], mean difference 95% confidence interval (CI) 0.91 (-3.08-4.91)). TWA-MAP was 93.1 ± 2.29 mmHg in Group H and 78.6 ± 2.97 mmHg in Group L (P < 0.05, mean difference 95% CI -14.5 (-15.4, -13.6)), indicating a statistically significant difference between the two groups. Conclusion: Maintaining higher or lower MAP intraoperatively had no significant effect on the quality of postoperative recovery in elderly frailty patients undergoing knee arthroplasty under the conditions studied in this trial.
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Wang et al. (2025) conducted an RCT in Frailty in elderly patients undergoing total knee arthroplasty (n=142). Low-level intraoperative mean arterial pressure vs. High-level intraoperative mean arterial pressure (MAP 85–100 mmHg) was evaluated on Quality of Recovery-15 (QoR-15) score on postoperative day 1 (MD 0.91, 95% CI -3.08-4.91, p=0.652). Maintaining a lower intraoperative mean arterial pressure (65-85 mmHg) compared to a higher target (85-100 mmHg) had no significant effect on the quality of postoperative recovery on day 1 in frail elderly patients undergoing knee arthroplasty.
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