Abstract
Little is known about the clinical importance of blood pressure variability (BPV) during anesthesia in non-cardiac surgery. We sought to investigate the impact of intraoperative BPV on postoperative mortality in non-cardiac surgery subjects, taking into account patient- and procedure-related variables. This prospective observational study covered 835 randomly selected patients who underwent gastrointestinal (n = 221), gynecological (n = 368) and neurosurgical (n = 246) procedures. Patient’s and procedure’s risks were assessed according to the validated tools and guidelines. Blood pressure (systolic, SBP, and diastolic, DBP) was recorded in five-minute intervals during anesthesia. Mean arterial pressure (MAP) was assessed. Individual coefficients of variation (Cv) were calculated. Postoperative 30-day mortality was considered the outcome. Median SBP_Cv was 11.2% (IQR 8.4–14.6), DBP_Cv was 12.7% (IQR 9.8–16.3) and MAP_Cv was 10.96% (IQR 8.26–13.86). Mortality was 2%. High SBP_Cv (i.e., ≥11.9%) was associated with increased mortality by 4.5 times (OR = 4.55; 95% CI 1.48–13.93; p = 0.008). High DBP_Cv (i.e., ≥22.4%) was associated with increased mortality by nearly 10 times (OR = 9.73; 95% CI 3.26–28.99; p < 0.001). High MAP_Cv (i.e., ≥13.6%) was associated with increased mortality by 3.5 times (OR = 3.44; 95% CI 1.34–8.83; p = 0.01). In logistic regression, it was confirmed that the outcome was dependent on both SBPV and DBPV, after adjustment for perioperative variables, with AUCSBP_Cv = 0.884 (95% CI 0.859–0.906; p < 0.001) and AUCDBP_Cv = 0.897 (95% CI 0.873–0.918; p < 0.001). Therefore, intraoperative BPV may be considered a prognostic factor for the postoperative mortality in non-cardiac surgery, and DBPV seems more accurate in outcome prediction than SBPV.
Highlights
Blood pressure (BP) is routinely monitored during anesthesia giving insight into organ perfusion in a safe, non-invasive way [1,2]
It was confirmed that the outcome was dependent on both SBPV and DBPV, after adjustment for perioperative variables, with AUCSBP_Cv = 0.884 and AUCDBP_Cv = 0.897
Mortality was only 2%, we demonstrated that BP variations were clearly among the factors increasing the risk of post-operative death, with a high diagnostic accuracy of the statistical model
Summary
Blood pressure (BP) is routinely monitored during anesthesia giving insight into organ perfusion in a safe, non-invasive way [1,2]. The effects of perioperative hypo- and hypertension on postoperative mortality have been extensively studied, both in cardiac and non-cardiac surgeries [4,5,6,7]. There is still a paucity of data regarding clinical importance of BP variations in non-cardiac surgery; though the number of studies focusing on ambulatory BP variability among non-surgical patients has risen in the last decade [2]. Perioperative variations may result from multiple patient- and environment-related factors. They may complicate perioperative homeostasis in a complex way.
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