Intraoperative arterial blood pressure lability is associated with improved 30 day survival

Levin, Matthew A.; Fischer, Gregory W.; Lin, Hung‐Mo; McCormick, Patrick J.; Krol, Marina; Reich, David L.

doi:10.1093/bja/aev293

Cited by 54 publications

(61 citation statements)

References 39 publications

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“…Although data available from a secondary analysis of the VISION trial suggest that intraoperative systolic arterial pressures >160 mm Hg are associated with myocardial injury and infarction, a large retrospective analysis of >52 000 adult non-cardiac surgical patients reported that those patients with MAP >120 mm Hg did not exhibit complications within the perioperative period. 34…”

Section: Consensus Statementsmentioning

confidence: 99%

Perioperative Quality Initiative consensus statement on intraoperative blood pressure, risk and outcomes for elective surgery

Aronson

Mythen

Grocott

et al. 2019

British Journal of Anaesthesia

412

327

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Background: Intraoperative mortality is now rare, but death within 30 days of surgery remains surprisingly common. Perioperative myocardial infarction is associated with a remarkably high mortality. There are strong associations between hypotension and myocardial injury, myocardial infarction, renal injury, and death. Perioperative arterial blood pressure management was thus the basis of a Perioperative Quality Initiative consensus-building conference held in London in July 2017. Methods: The meeting featured a modified Delphi process in which groups addressed various aspects of perioperative arterial pressure.

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Section: Consensus Statementsmentioning

confidence: 99%

Perioperative Quality Initiative consensus statement on intraoperative blood pressure, risk and outcomes for elective surgery

Aronson

Mythen

Grocott

et al. 2019

British Journal of Anaesthesia

412

327

View full text Add to dashboard Cite

show abstract

“…They found an inverse association between the number of episodes of lability and the 30-day mortality [9]. Mascha et al [10] calculated the time-weighted averages of the mean arterial pressures (TWA-MAP) and also the average real variability of the mean arterial pressure (ARV-MAP) as a measure of variability.…”

Section: Discussionmentioning

confidence: 99%

“…Recently there has been growing interest in perioperative fluctuations in blood pressure termed as 'blood pressure variability' and their assocaitons with adverse outcomes [4,[8][9][10][11]. Aronson et al [4] studied the time spent outside a specific systolic BP range in cardiac surgical patients.…”

Section: Introductionmentioning

confidence: 99%

Cardiac surgical outcome prediction by blood pressure variability indices Poincaré plot and coefficient of variation: a retrospective study

et al. 2020

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Background: Recent literature suggests a significant association between blood pressure variability (BPV) and postoperative outcomes after cardiac surgery. However, its outcome prediction ability remains unclear. Current prediction models use static preoperative patient factors. We explored the ability of Poincaré plots and coefficient of variation (CV) by measuring intraoperative BPV in predicting adverse outcomes. Methods: In this retrospective, observational, cohort study, 3687 adult patients (> 18 years) undergoing cardiac surgery requiring cardio-pulmonary bypass from 2008 to 2014 were included. Blood pressure variability was computed by Poincare plots and CV. Standard descriptors (SD) SD1, SD2 were measured with Poincare plots by ellipse fitting technique. The outcomes analyzed were the 30-day mortality and postoperative renal failure. Logistic regression models adjusted for preoperative and surgical factors were constructed to evaluate the association between BPV parameters and outcomes. C-statistics were used to analyse the predictive ability. Results: Analysis found that, 99 (2.7%) patients died within 30 days and 105 (2.8%) patients suffered from inhospital renal failure. Logistic regression models including BPV parameters (standard descriptors from Poincare plots and CV) performed poorly in predicting postoperative 30-day mortality and renal failure [Concordance(C)-Statistic around 0.5]. They did not add any significant value to the standard STS risk score [C-statistic: STS alone 0.7, STS + BPV parmeters 0.7]. Conclusions: In conclusion, BP variability computed from Poincare plots and CV were not predictive of mortality and renal failure in cardiac surgical patients. Patient comorbid conditions and other preoperative factors are still the gold standard for outcome prediction. Future directions include analysis of dynamic parameters such as complexity of physiological signals in identifying high risk patients and tailoring management accordingly.

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“…Indeed, intraoperative hypotension is associated with an increased risk of myocardial injury, acute kidney injury, and even 30-day mortality [8,9,28,30]. Furthermore, it seems that these harmful effects last long time after surgery.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative hypotension is associated with shortened overall survival after lung cancer surgery

Huang

Zhu

et al. 2020

Preprint

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Abstract Background: Intraoperative hypotension is associated with worse perioperative outcomes, but evidence is lacking regarding long-term survival after cancer surgery. Herein, we analyzed the association between intraoperative blood pressure fluctuation and overall survival after lung cancer surgery. Methods: In this retrospective cohort study, 676 patients who received lung cancer surgery between January 1, 2006 and December 31, 2009 were reviewed. Intraoperative hyper- and hypotension were defined according to their correlation with long-term survival. The primary endpoint was overall survival. The association between intraoperative blood pressure fluctuation and overall survival was analyzed with multivariable Cox proportional hazard models. Results: Long-term follow-ups were completed in 515 patients with a median duration of 5.2 years. The estimated 5-year survival rates were 66.5%, 61.3%, 56.5%, and 41.2% in patients with only hypertension (systolic blood pressure >140 mmHg for ³5 minutes), with both hyper- and hypotension (systolic blood pressure <100 mmHg for ³5 minutes), with neither hyper- nor hypotension, and with only hypotension during surgery, respectively. After adjusting confounding factors, intraoperative hypotension was significantly associated with shortened overall survival (compared with patients with only intraoperative hypertension, those with both hyper- and hypotension: hazard ratio [HR]1.033, 95% confidence interval [CI] 0.709 to 1.507, p=0.864; those with neither hyper- nor hypotension: HR 0.952, 95% CI 0.608 to 1.489, p=0.829; those with only hypotension: HR 1.736, 95% CI 1.218 to 2.475, p=0.002). Conclusions: For patients undergoing lung cancer surgery, intraoperative hypotension, but not hypertension, was associated with shortened overall survival.

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Intraoperative arterial blood pressure lability is associated with improved 30 day survival

Abstract: Intraoperative arterial blood pressure lability occurs more often in hypertensive patients. Contrary to common belief, increased lability was associated with decreased 30 day mortality.

Cited by 54 publications

References 39 publications

Perioperative Quality Initiative consensus statement on intraoperative blood pressure, risk and outcomes for elective surgery

Perioperative Quality Initiative consensus statement on intraoperative blood pressure, risk and outcomes for elective surgery

Cardiac surgical outcome prediction by blood pressure variability indices Poincaré plot and coefficient of variation: a retrospective study

Intraoperative hypotension is associated with shortened overall survival after lung cancer surgery

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