Postinduction hypotension was not associated with 30-day postoperative mortality (aOR 1.03), whereas intraoperative hypotension was significantly associated with increased 30-day mortality (aOR 1.19).
Cohort (n=14,210)
No
Does postinduction hypotension increase 30-day and 90-day postoperative mortality in adult patients undergoing noncardiac and nonobstetric surgery?
Intraoperative hypotension, but not postinduction hypotension, is significantly associated with increased 30-day and 90-day postoperative mortality in patients undergoing noncardiac surgery.
Effect estimate: aOR 1.03 (95% CI 0.93 to 1.13)
p-value: p=0.60
PURPOSE: We aimed to elucidate whether postinduction hypotension (PIH), defined as hypotension between anesthesia induction and skin incision, and intraoperative hypotension (IOH) are associated with postoperative mortality. METHODS: We conducted a retrospective cohort study of adult patients with an ASA Physical Status I-IV who underwent noncardiac and nonobstetric surgery under general anesthesia between 2015 and 2021 at Nagoya City University Hospital. The primary and secondary outcomes were 30-day and 90-day postoperative mortality, respectively. We calculated four hypotensive indices (with time proportion of the area under the threshold being the primary exposure variable) to evaluate the association between hypotension (defined as a mean blood pressure < 65 mm Hg) and mortality using multivariable logistic regression models. We used propensity score matching and RUSBoost (random under-sampling and boosting), a machine-learning model for imbalanced data, for sensitivity analyses. RESULTS: Postinduction hypotension and IOH were observed in 82% and 84% of patients, respectively. The 30-day and 90-day postoperative mortality rates were 0.4% (52/14,210) and 1.0% (138/13,334), respectively. Postinduction hypotension was not associated with 30-day mortality (adjusted odds ratio aOR, 1.03; 95% confidence interval CI, 0.93 to 1.13; P = 0.60) and 90-day mortality (aOR, 1.01; 95% CI, 0.94 to 1.07; P = 0.82). Conversely, IOH was associated with 30-day mortality (aOR, 1.19; 95% CI, 1.12 to 1.27; P < 0.001) and 90-day mortality (aOR, 1.12; 95% CI, 1.06 to 1.19; P < 0.001). Sensitivity analyses supported the association of IOH but not PIH with postoperative mortality. CONCLUSION: Despite limitations, including power and residual confounding, postoperative mortality was associated with IOH but not with PIH.
Nakanishi et al. (Tue,) conducted a cohort in Noncardiac and nonobstetric surgery under general anesthesia (n=14,210). Postinduction hypotension vs. No postinduction hypotension was evaluated on 30-day postoperative mortality (aOR 1.03, 95% CI 0.93 to 1.13, p=0.60). Postinduction hypotension was not associated with 30-day postoperative mortality (aOR 1.03), whereas intraoperative hypotension was significantly associated with increased 30-day mortality (aOR 1.19).