Hypotension as a marker or mediator of perioperative organ injury: a narrative review

Ackland, Gareth L.; Abbott, Tom

doi:10.1016/j.bja.2022.01.012

Cited by 25 publications

(16 citation statements)

References 153 publications

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“…Based on these results, we considered the underlying relationship between surgical mortality and low PMA. Frail patients have reduced baroreflex sensitivity and vagal function, which may predispose them to IOH [ 21 ]. Soysal et al [ 30 ] showed the relationship between the severity of sarcopenia and orthostatic hypotension accompanied by decreased function of their cardiovascular function to maintain blood pressure.…”

Section: Discussionmentioning

confidence: 99%

“…Intraoperative hypotension (IOH) is associated with mortality and adverse postoperative outcomes, such as acute kidney injury [ 17 ], myocardial injury [ 18 ], and stroke [ 19 ]. IOH is associated with postoperative outcomes and frequently occurs in frail patients; they typically have a higher sympathetic drive and reduced baroreflex sensitivity, which leads to IOH [ 20 , 21 ]. The association between low PMA and adverse surgical outcomes in older adult patients with hip fractures has been described [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

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Predictability of Radiologically Measured Psoas Muscle Area for Intraoperative Hypotension in Older Adult Patients Undergoing Femur Fracture Surgery

Lee

Woo

Yoon

et al. 2023

JCM

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This retrospective study aimed to determine the predictive value of radiologically measured psoas muscle area (PMA) for intraoperative hypotension (IOH) using receiver operating characteristic (ROC) curves in older adult patients with hip fractures. The cross-sectional axial area of the psoas muscle was measured by CT at the level of the 4th lumbar vertebrae and normalized by body surface area (BSA). The modified frailty index (mFI) was used to assess frailty. IOH was defined as an absolute threshold of mean arterial blood pressure (MAP) < 65 mmHg or a relative decrease in MAP > 30% from baseline MAP. Among the 403 patients, 286 (71.7%) had developed IOH. PMA normalized by BSA in male patients was 6.90 ± 0.73 in the no-IOH group and 4.95 ± 1.20 in the IOH group (p < 0.001). PMA normalized by BSA in female patients was 5.18 ± 0.81 in the no-IOH group and 3.78 ± 0.75 in the IOH group (p < 0.001). The ROC curves showed that the area under the curve for PMA normalized by BSA and modified frailty index (mFI) were 0.94 for male patients, 0.91 for female patients, and 0.81 for mFI (p < 0.001). In multivariate logistic regression, low PMA normalized by BSA, high baseline systolic blood pressure, and old age were significant independent predictors of IOH (adjusted odds ratio: 3.86, 1.03, and 1.06, respectively). PMA measured by computed tomography showed an excellent predictive value for IOH. Low PMA was associated with developing IOH in older adult patients with hip fractures.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Predictability of Radiologically Measured Psoas Muscle Area for Intraoperative Hypotension in Older Adult Patients Undergoing Femur Fracture Surgery

Lee

Woo

Yoon

et al. 2023

JCM

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“…Longer waiting time to hip fracture surgery has previously been shown to be associated with intraoperative hypotension ( 8 ). However, hypotension alone cannot fully explain perioperative organ injury, and has been suggested to be a biomarker rather than a direct mediator ( 22 ).…”

Section: Methodsmentioning

confidence: 99%

Waiting more than 24 hours for hip fracture surgery is associated with increased risk of adverse outcomes for sicker patients: a nationwide cohort study of 63,998 patients using the Swedish Hip Fracture Register

Greve

Bartha

et al. 2023

ActaO

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Background and purpose: Waiting time to surgery is a modifiable risk factor in hip fracture surgery. However, there is no consensus regarding the acceptable duration of waiting time. We used the Swedish Hip Fracture Register RIKSHÖFT and 3 administrative registers to explore the association between time to surgery and adverse outcomes after discharge.Patients and methods: 63,998 patients ≥ 65 years, admitted to a hospital between January 1, 2012, and August 31, 2017 were included. Time to surgery was divided into < 12, 12–24, and > 24 hours. Diagnoses investigated were atrial fibrillation/flutter (AF), congestive heart failure (CHF), pneumonia, and “acute ischemia” (a combination of stroke/intracranial bleeding, myocardial infarction, and acute kidney injury). Crude and adjusted survival analyses were performed. Time spent in hospital following the initial hospitalization was described for the 3 groups.Results: Waiting > 24 hours was associated with an increased risk of AF (HR 1.4, 95%CI 1.2–1.6), CHF (HR 1.3, CI 1.1–1.4) and “acute ischemia” (HR 1.2, CI 1.01–1.3). However, stratifying for ASA grade revealed that these associations were present only in patients with ASA 3–4. There was no association between waiting time and pneumonia after the initial hospitalization (HR 1.1, CI 0.97–1.2), but one was found with pneumonia during hospital stay OR 1.2 (CI 1.1–1.4). Time in hospital after the initial hospitalization was similar over the waiting time groups.Conclusion: The associations between waiting > 24 hours for hip fracture surgery and AF, CHF, and acute ischemia suggest that shorter waiting time may reduce adverse outcomes for the sicker patients.

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“…Despite knowledge of the risk factors for development of AKI, there has been no reduction in the incidence of the disease over the past 20 years and specific renal protection and treatment strategies have not shown any benefit. It may be the case that the damage is already done secondary to the inflammatory effects of cardiopulmonary bypass and the surgery itself causing tissue damage, with hypotension being a marker of this damage rather than the primary cause of hypoperfusion [16]. Maintaining blood pressure postoperatively may help to prevent secondary renal injury but we may never be able to prevent AKI in some patients.…”

Section: Angiotensin-2mentioning

confidence: 99%

Renal failure in cardiac surgery: in search of the magic bullet

et al. 2022

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Hypotension as a marker or mediator of perioperative organ injury: a narrative review

Cited by 25 publications

References 153 publications

Predictability of Radiologically Measured Psoas Muscle Area for Intraoperative Hypotension in Older Adult Patients Undergoing Femur Fracture Surgery

Predictability of Radiologically Measured Psoas Muscle Area for Intraoperative Hypotension in Older Adult Patients Undergoing Femur Fracture Surgery

Waiting more than 24 hours for hip fracture surgery is associated with increased risk of adverse outcomes for sicker patients: a nationwide cohort study of 63,998 patients using the Swedish Hip Fracture Register

Renal failure in cardiac surgery: in search of the magic bullet

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