Elevated preoperative blood pressures in adult surgical patients are highly predictive of elevated home blood pressures

Schonberger, Robert B.; Nwozuzu, Adambeke; Zafar, Jill; Chen, Eric; Kigwana, Simon; Monteiro, Miriam M.; Charchaflieh, Jean; Sophanphattana, Sophisa; Dai, Feng; Burg, Matthew M.

doi:10.1016/j.jash.2018.01.012

Cited by 11 publications

(12 citation statements)

References 32 publications

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“…Of the forty-nine home blood pressure monitors provided, 46 (94%) were returned, consistent with our prior experience of adherence to such monitoring among study participants in the preoperative population (Schonberger et al 2018 ). The median number of blood pressure readings among these participants was 26 (IQR = 16-46).…”

Section: Resultssupporting

confidence: 73%

“…Within the field of anesthesiology, the Merit-Based Incentive Program (MIPS) included hypertension screening in its 2007 anesthesiology specific quality metrics, and subsequent literature established plausible thresholds at which preoperative blood pressures appeared reasonably predictive of longitudinal blood pressure elevation (Schonberger et al 2012 ; Schonberger et al 2015 ; Schonberger et al 2018 ). Nevertheless, while isolated teams have attempted to bring hypertension screening and treatment into perioperative workflows (Pfister et al 2020 ), randomized interventional studies based on these efforts have remained unexplored.…”

Section: Introductionmentioning

confidence: 99%

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Feasibility of a randomized hypertension screening initiative in the perioperative setting

et al. 2021

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Objectives This study sought to assess feasibility of a randomized trial of blood pressure intervention (home blood pressure monitoring vs. counseling) in the preoperative clinic and the baseline rates of primary care follow-up after such interventions. Methods A prospective randomized feasibility study was performed at Yale New Haven Hospital Preadmission Testing Clinic. A sample of 100 adults, with elevated blood pressure, were recruited during their preadmission visit, and randomized 1:1 to receive brief BP counseling and an educational brochure versus additionally receiving a home BP monitor (HBPM) with a mailed report of their home readings. At 60-day post-surgery telephone follow-up, investigators asked whether participants had primary-care follow-up; had new/adjusted hypertension treatment; and felt satisfied with the study. Results There were 51 patients in the counseling group and 49 in the HBPM group. Of 46 patients in the HBPM group who returned their monitors, 36 (78%) were hypertensive at home. At 60 days post-surgery, 31 (61%) patients in the counseling group and 30 (61%) in the HBPM group were reached by telephone with the remaining followed by EHR. Thirty-six (71%) patients in the counseling group and 36 (73%) in the HBPM group had seen their primary care provider. Seventeen of 36 (47%) in the counseling group and 18 of 31 (58%) in the HBPM group received new or adjusted hypertension medications. Sixty-one participants answered questions regarding their satisfaction with the study with 52 (85%) reporting that they felt moderately to very satisfied. Conclusions This feasibility study suggests that interventional blood pressure trials in the preoperative clinic are feasible, but telephone follow-up leads to significant gaps in outcome ascertainment. Trial registration Clinicaltrials.gov, NCT03634813. Registered 16 of August 2018.

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Section: Resultssupporting

confidence: 73%

Section: Introductionmentioning

confidence: 99%

Feasibility of a randomized hypertension screening initiative in the perioperative setting

et al. 2021

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“…Schonberger et al observed significantly higher preoperative office BP levels than home BP levels, and they confirmed that elevated preoperative BP values usually correspond to poorly controlled or even undiagnosed hypertension. 23 The incidence of poorly controlled or even undiagnosed hypertension in our patients, especially outpatients, might be relatively high because there are fewer opportunities for BP monitoring by a professional before surgery; this issue needs further study. Additionally, for outpatients, same-day surgery means taking a long trip to the hospital, having an irregular diet and sleeping at a hotel near the hospital before surgery, getting up early on the day of surgery and going through the tedious hospitalization procedures.…”

Section: Discussionmentioning

confidence: 92%

Same-Day Cancellation is Higher in Outpatient Pars Plana Vitrectomy for Proliferative Diabetic Retinopathy

Chu¹,

Zhang²,

Yue³

et al. 2022

RMHP

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Purpose Safety and efficiency of ambulatory pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR) patients is worthy of attention, since patients always have severe systemic diseases. The purpose of this study was to compare the incidence of same-day cancellation of PPV for PDR between outpatients and inpatients and to analyze the causes of cancellations. Patients and Methods This is a retrospective review of consecutive PPV procedures for PDR from January 2019 to April 2021 at either the ambulatory or the inpatient surgery center in an academic tertiary referral center. Data on patient surgery plan, same-day surgical cancellation and follow-up were recorded. Differences in cancellation rate and reasons for cancellation (e.g. medical factors, patient reasons and administrative problems) between outpatients and inpatients were compared. Results In total, 1810 consecutive PPV procedures of 1367 patients were identified; 1509 (83.4%) were managed as inpatient surgeries and 301 (16.6%) as outpatient surgeries. The total same-day cancellation rate was 5.2% for all patients. Although outpatients were younger (51 years vs 52 years, P < 0.001), had less proportion of hypertension (60.5% vs 74.0%), coronary artery disease (10.0% vs 18.8%), renal insufficiency (9.3% vs 18.0%) and cerebrovascular diseases (1.0% vs 11.4%) (all P < 0.001), had less proportion of patients with ASA III status (14.9% vs 27.4%, P < 0.001), and had higher proportion of regional anesthesia with MAC (19.9% vs 5.0%, P < 0.001), the cancellation proportion was significantly higher for outpatients than inpatients (12.3% vs 3.8%, P < 0.001). Overall, the most common reason for surgical cancellation was medical factors, occurring more frequently in outpatients than inpatients (91.9% vs 68.4%, P = 0.012). Conclusion Same-day cancellation is higher in outpatient pars plana vitrectomy for proliferative diabetic retinopathy. To reduce ambulatory surgery cancellations, it is important to strengthen the monitoring of preoperative systemic comorbidities and adjust medication if necessary.

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“…It is possible that such measurement does not represent a true “baseline” as it could be influenced by stress or premedication. However, it was demonstrated that BP measurements obtained on the day of the surgery were similar to those obtained via primary care [ 22 ]. Secondly, due to the fact that BP was measured in 5-min intervals, we chose not to quantify the duration of IOH in minutes but in episodes.…”

Section: Discussionmentioning

confidence: 99%

Association between Intraoperative Blood Pressure Drop and Clinically Significant Hypoperfusion in Abdominal Surgery: A Cohort Study

Putowski

Czajka

Krzych

2021

JCM

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The recent consensus by the Perioperative Quality Initiative (POQI) on intraoperative hypotension (IOH) stated that mean arterial pressure (MAP) below 60–70 mmHg is associated with myocardial infarction (MI), acute kidney injury (AKI), death and also that IOH is a function of not only severity but also of duration. However, most of the data come from large, heterogeneous cohorts of patients who underwent different surgical procedures and types of anaesthesia. We sought to assess how various definitions of IOH can predict clinically significant hypoperfusive outcomes in a homogenous cohort of generally anesthetised patients undergoing abdominal surgery, taking into account thresholds of MAP and their time durations. The data for this study come from a prospective cohort study in which patients who underwent abdominal surgery between 1 October 2018 and 15 July 2019 in the university hospital in Katowice were included in the analysis. We analysed perioperative data to assess how various IOH thresholds can predict hypoperfusive outcomes (defined as myocardial injury, acute kidney injury or stroke). 508 patients were included in the study. The total number of cases of clinically significant hypoperfusion was 38 (7.5%). We found that extending durations of low MAP, i.e., below 55 mmHg, 60 mmHg, 65 mmHg and 70 mmHg, were associated with the development of either AKI, MI or stroke. It was observed that for narrower and lower hypotension thresholds, the time required to induce complications is shorter. Patients who suffered from AKI/MI/Stroke experienced more episodes of any of the IOH definitions applied. Absolute IOH thresholds were superior to the relative definitions. For patients undergoing abdominal surgery, it is vital to prevent the extended durations of intraoperative mean arterial pressure below 70 mmHg. Finally, there appears to be no need to guide intraoperative haemodynamic therapy based on pre-induction values and, consequently, on relative drops of MAP.

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Elevated preoperative blood pressures in adult surgical patients are highly predictive of elevated home blood pressures

Cited by 11 publications

References 32 publications

Feasibility of a randomized hypertension screening initiative in the perioperative setting

Feasibility of a randomized hypertension screening initiative in the perioperative setting

Same-Day Cancellation is Higher in Outpatient Pars Plana Vitrectomy for Proliferative Diabetic Retinopathy

Association between Intraoperative Blood Pressure Drop and Clinically Significant Hypoperfusion in Abdominal Surgery: A Cohort Study

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