Can routine perioperative haemodynamic parameters predict postoperative morbidity after major surgery?

Bonnet, Jean-Francois; Buggy, Eleanor; Cusack, Barbara; Sherwin, Aislinn; Wall, Tom; Fitzgibbon, Maria; Buggy, Donal J.

doi:10.1186/s13741-020-0139-6

Cited by 10 publications

(6 citation statements)

References 24 publications

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“…Intra-operative hypotension frequently complicates anaesthesia and has been extensively associated with myocardial injury, acute kidney injury (AKI), stroke and death [1][2][3][4][5][6][7][8]. Older patients are particularly vulnerable to peri-operative haemodynamic disturbances and organ dysfunction [9] due to a combination of comorbid disease and frailty. Although the measurement of blood pressure is only one component and a simplification of haemodynamic status, intra-operative hypotension is increasingly implicated in the pathogenesis of peri-operative end-organ dysfunction via concomitant effects of hypoperfusion and ischaemia [10].…”

Section: Introductionmentioning

confidence: 99%

Treatment threshold for intra‐operative hypotension in clinical practice—a prospective cohort study in older patients in the UK

et al. 2021

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Intra-operative hypotension frequently complicates anaesthesia in older patients and is implicated in perioperative organ hypoperfusion and injury. The prevalence and corresponding treatment thresholds of hypotension are incompletely described in the UK. This study aimed to identify prevalence of intra-operative hypotension and its treatment thresholds in UK practice. Patients aged ≥ 65 years were studied prospectively from 196 UK hospitals within a 48-hour timeframe. The primary outcome was the incidence of hypotension (mean arterial pressure <65 mmHg; systolic blood pressure reduction >20%; systolic blood pressure <100 mmHg). Secondary outcomes included the treatment blood pressure threshold for vasopressors; incidence of acute kidney injury; myocardial injury; stroke; and in-hospital mortality. Additionally, anaesthetists providing care for included patients were asked to complete a survey assessing their intended treatment thresholds for hypotension. Data were collected from 4750 patients. Hypotension affected 61.0% of patients when defined as mean arterial pressure <65 mmHg, 91.3% of patients had >20% reduction in systolic blood pressure from baseline and 77.5% systolic blood pressure <100 mmHg. The mean (SD) blood pressure triggering vasopressor therapy was mean arterial pressure 64.2 (11.6) mmHg and the mean (SD) stated intended treatment threshold from the survey was mean arterial pressure 60.6 (9.7) mmHg. A composite adverse outcome of myocardial injury, kidney injury, stroke or death affected 345 patients (7.3%). In this representative sample of UK peri-operative practice, the majority of older patients experienced intra-operative hypotension and treatment was delivered below suggested thresholds. This highlights both potential for intraoperative organ injury and substantial opportunity for improving treatment of intra-operative hypotension.

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Section: Introductionmentioning

confidence: 99%

Treatment threshold for intra‐operative hypotension in clinical practice—a prospective cohort study in older patients in the UK

et al. 2021

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“…Other studies such as that of Roshanov et al . [ 56 ] reported hypotensive events in postoperative days 0 and 1 was also found to be associated with increased length of hospital stay (OR 1.305, p = 0.0239) [ 14 , 21 ]; and sepsis/systemic inflammatory response syndrome [ 23 ]. Other outcomes that were investigated were: surgical site infection, that was found to be not statistically significant in relation to MAP <55 mmHg and SBP <80 mmHg, but odds of 1.08 were found in association with minimum postoperative MAP, per 5 mmHg decrease by Yilmaz et al .…”

Section: Resultsmentioning

confidence: 99%

The burden of perioperative hypertension/hypotension: A systematic review

et al. 2022

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Study objective Our goal is to review the outcomes of acute hypertensive/hypotensive episodes from articles published in the past 10 years that assessed the short- and long-term impact of acute hypertensive/hypotensive episodes in the perioperative setting. Methods We conducted a systematic peer review based upon PROSPERO and Cochrane Handbook protocols. The following study characteristics were collected: study type, author, year, population, sample size, their definition of acute hypertension, hypotension or other measures, and outcomes (probabilities, odds ratio, hazard ratio, and relative risk) and the p-values; and they were classified according to the type of surgery (cardiac and non-cardiac). Results A total of 3,680 articles were identified, and 66 articles fulfilled the criteria for data extraction. For the perioperative setting, the number of articles varies by outcome: 20 mortality, 16 renal outcomes, 6 stroke, 7 delirium and 34 other outcomes. Hypotension was reported to be associated with mortality (OR 1.02–20.826) as well as changes from the patient’s baseline blood pressure (BP) (OR 1.02–1.36); hypotension also had a role in the development of acute kidney injury (AKI) (OR 1.03–14.11). Postsurgical delirium was found in relation with BP lability (OR 1.018–1.038) and intra- and postsurgical hypotension (OR 1.05–1.22), and hypertension (OR 1.44–2.34). Increased OR (37.67) of intracranial hemorrhage was associated to postsurgical systolic BP >130 mmHg. There was a wide range of additional diverse outcomes related to hypo-, hypertension and BP lability. Conclusions The perioperative management of BP influences short- and long-term effects of surgical procedures in cardiac and non-cardiac interventions; these findings support the burden of BP fluctuations in this setting.

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“…Postoperative mortality remains common, with a 30-day incidence of 1% to 2% . Major complications, depending on how they are defined, are about 10 times more common than deaths . Enhanced Recovery After Surgery (ERAS) protocols are perioperative pathways designed to promote recovery, expedite healing, and reduce postoperative complications .…”

Section: Introductionmentioning

confidence: 99%

“…1,2 Major complications, depending on how they are defined, are about 10 times more common than deaths. 3,4 Enhanced Recovery After Surgery (ERAS) protocols are perioperative pathways designed to promote recovery, expedite healing, and reduce postoperative complications. 5 Prompt postsurgical mobilization is an important component of most ERAS protocols based on improved venous stasis, reduced insulin resistance, and muscle strengthening.…”

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confidence: 99%

Association Between Mobilization and Composite Postoperative Complications Following Major Elective Surgery

et al. 2023

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ImportanceMobilization after surgery is a key component of Enhanced Recovery after Surgery (ERAS) pathways.ObjectiveTo evaluate the association between mobilization and a collapsed composite of postoperative complications in patients recovering from major elective surgery as well as hospital length of stay, cumulative pain scores, and 30-day readmission rates.Design, Setting, and ParticipantsThis retrospective observational study conducted at a single quaternary US referral center included patients who had elective surgery between February 2017 and October 2020. Mobilization was assessed over the first 48 postoperative hours with wearable accelerometers, and outcomes were assessed throughout hospitalization. Patients who had elective surgery lasting at least 2 hours followed by at least 48 hours of hospitalization were included. A minimum of 12 hours of continuous accelerometer monitoring was required without missing confounding variables or key data. Among 16 203 potential participants, 8653 who met inclusion criteria were included in the final analysis. Data were analyzed from February 2017 to October 2020.ExposuresAmount of mobilization per hour for 48 postoperative hours.OutcomesThe primary outcome was a composite of myocardial injury, ileus, stroke, venous thromboembolism, pulmonary complications, and all-cause in-hospital mortality. Secondary outcomes included hospital length of stay, cumulative pain scores, and 30-day readmission.ResultsOf 8653 included patients (mean [SD] age, 57.6 [16.0] years; 4535 [52.4%] female), 633 (7.3%) experienced the primary outcome. Mobilization time was a median (IQR) of 3.9 (1.7-7.8) minutes per monitored hour overall, 3.2 (0.9-7.4) in patients who experienced the primary outcome, and 4.1 (1.8-7.9) in those who did not. There was a significant association between postoperative mobilization and the composite outcome (hazard ratio [HR], 0.75; 95% CI, 0.67-0.84; P &lt; .001) for each 4-minute increase in mobilization. Mobilization was associated with an estimated median reduction in the duration of hospitalization by 0.12 days (95% CI, 0.09-0.15; P &lt; .001) for each 4-minute increase in mobilization. The were no associations between mobilization and pain score or 30-day readmission.Conclusions and RelevanceIn this study, mobilization measured by wearable accelerometers was associated with fewer postoperative complications and shorter hospital length of stay.

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Can routine perioperative haemodynamic parameters predict postoperative morbidity after major surgery?

Cited by 10 publications

References 24 publications

Treatment threshold for intra‐operative hypotension in clinical practice—a prospective cohort study in older patients in the UK

Treatment threshold for intra‐operative hypotension in clinical practice—a prospective cohort study in older patients in the UK

The burden of perioperative hypertension/hypotension: A systematic review

Association Between Mobilization and Composite Postoperative Complications Following Major Elective Surgery

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