Relation between elevated first SBP from baseline (delta SBP) and postoperative outcome

Abstract

Background: Hypertension is associated with increased postoperative risk. However, no consensus was accepted whether elevated blood pressure in the operating room with normal blood pressure at rest related to additional cardiovascular risk. Methods: This was a single-center retrospective cohort study based on patients who underwent elective noncardiac surgery from 1 January 2012, to 31 December 2018. We evaluated the relationship between the delta SBP (the difference between first operating room blood pressure and baseline blood pressure) and the development of postoperative major adverse cardiac events (MACEs) in patients with normal baseline blood pressure. Multivariate logistic regression before and after propensity score weighting was performed to adjust for perioperative variables, and the minimum P value approach was used to identify the possible threshold of delta SBP that independently indicated the risk of MACE. Results: Of the 55 563 surgeries, in 4.1%, postoperative MACE occurred. The threshold for the delta SBP was 49 mmHg. The adjusted odds ratio for MACE before and after propensity score weighting for the delta SBP threshold was 1.35 (95% CI, 1.11--1.59); P less than 0.001 and 1.28 (1.03–1.60); P = 0.028, respectively. Conclusion: Delta SBP contributed to the elevated risk over and beyond the SBP at rest in patients who underwent elective noncardiac surgery. A rise of SBP of more than 49 mmHg from baseline in the operating room was significantly associated with an increased risk of postoperative MACE.

Consideraciones perioperatorias en pacientes con hipertensión: el día de su cirugía

“…El estrés perioperatorio de ser sometido a una intervención quirúrgica induce cambios importantes de las cifras de PA de los pacientes hipertensos en quienes se producen elevaciones a pesar de tener adecuado control habitual de la PA. Wax et al, en un estudio observacional retrospectivo de 209.985 pacientes encontraron que 21.126 (10%) de pacientes con PA superior a 140/90 mmHg, que denominaron "hipertensión preanestésica" [28]. En un estudio de cohorte retrospectivo unicéntrico [29] en 55.595 pacientes sometidos a cirugía electiva no cardíaca, se encontró que la mediana del aumento de la presión arterial sistólica (PAS) de los pacientes fue 14 mmHg [10]- [20] en la primera medición anestésica respecto a los valores ambulatorios. En esta cohorte evidenciaron que un aumento de 49 mmHg de la PAS versus la basal, se asoció a un aumento de eventos cardiovasculares con un OR 1,35 (95% CI, 1,11 -1,59).…”