Association between Preoperative Blood Pressures and Postoperative Adverse Events.

IF 9.1 1区医学 Q1 ANESTHESIOLOGY Anesthesiology Pub Date : 2024-08-01 DOI:10.1097/ALN.0000000000004991

Jeremy P Walco, Kimberly F Rengel, Matthew D McEvoy, C Patrick Henson, Gen Li, Matthew S Shotwell, Xiaoke Feng, Robert E Freundlich

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Abstract

Background: The relationship between postoperative adverse events and blood pressures in the preoperative period remains poorly understood. This study tested the hypothesis that day-of-surgery preoperative blood pressures are associated with postoperative adverse events.

Methods: The authors conducted a retrospective, observational study of adult patients having elective procedures requiring an inpatient stay between November 2017 and July 2021 at Vanderbilt University Medical Center to examine the independent associations between preoperative systolic and diastolic blood pressures (SBP, DBP) recorded immediately before anesthesia care and number of postoperative adverse events-myocardial injury, stroke, acute kidney injury, and mortality-while adjusting for potential confounders. The study used multivariable ordinal logistic regression to model the relationship.

Results: The analysis included 57,389 cases. The overall incidence of myocardial injury, stroke, acute kidney injury, and mortality within 30 days of surgery was 3.4% (1,967 events), 0.4% (223), 10.2% (5,871), and 2.1% (1,223), respectively. The independent associations between both SBP and DBP measurements and number of postoperative adverse events were found to be U-shaped, with greater risk both above and less than SBP 143 mmHg and DBP 86 mmHg-the troughs of the curves. The associations were strongest at SBP 173 mmHg (adjusted odds ratio, 1.212 vs. 143 mmHg; 95% CI, 1.021 to 1.439; P = 0.028), SBP 93 mmHg (adjusted odds ratio, 1.339 vs. 143 mmHg; 95% CI, 1.211 to 1.479; P < 0.001), DBP 106 mmHg (adjusted odds ratio, 1.294 vs. 86 mmHg; 95% CI, 1.003 to 1.17671; P = 0.048), and DBP 46 mmHg (adjusted odds ratio, 1.399 vs. 86 mmHg; 95% CI, 1.244 to 1.558; P < 0.001).

Conclusions: Preoperative blood pressures both less than and above a specific threshold were independently associated with a higher number of postoperative adverse events, but the data do not support specific strategies for managing patients with low or high blood pressure on the day of surgery.

Editor’s perspective:

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术前血压与术后不良事件之间的关系。

背景：人们对术后不良事件与术前血压之间的关系仍然知之甚少。本研究检验了手术当天术前血压与术后不良事件相关的假设：我们对2017年11月至2021年7月期间在范德比尔特大学医学中心接受择期手术并需要住院治疗的成年患者进行了一项回顾性观察研究，以检验麻醉护理前记录的术前收缩压和舒张压（SBP、DBP）与术后不良事件（心肌损伤、卒中、急性肾损伤（AKI）和死亡率）数量之间的独立关联，同时调整潜在的混杂因素。我们使用多变量序数逻辑回归来模拟两者之间的关系：分析包括 57,389 个病例。手术后 30 天内心肌损伤、中风、AKI 和死亡率的总发生率分别为 3.4%（1967 例）、0.4%（223 例）、10.2%（5871 例）和 2.1%（1223 例）。研究发现，SBP 和 DBP 测量值与术后不良事件数量之间的独立关联呈 U 型，在 SBP 143 mmHg 和 DBP 86 mmHg 以上和以下（即曲线的谷底）风险更大。在 SBP 173 mmHg（调整后比值比 [aOR] 1.212 对 143 mmHg；95% CI，1.021 对 1.439；p = 0.028）、SBP 93 mmHg（调整后比值比 [aOR] 1.339 对 143 mmHg；95% CI，1.211 对 1.479; p < 0.001），DBP 106 mmHg (aOR 1.294 对 86 mmHg; 95% CI, 1.003 to 1.17671; p = 0.048)，DBP 46 mmHg (aOR 1.399 对 86 mmHg; 95% CI, 1.244 to 1.558; p < 0.001).结论：术前血压低于或高于特定阈值与较高的术后不良事件发生率有关，但数据并不支持对手术当天血压偏低或偏高的患者采取特定的管理策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Anesthesiology 医学-麻醉学

CiteScore

10.40

自引率

5.70%

发文量

542

审稿时长

3-6 weeks

期刊介绍： With its establishment in 1940, Anesthesiology has emerged as a prominent leader in the field of anesthesiology, encompassing perioperative, critical care, and pain medicine. As the esteemed journal of the American Society of Anesthesiologists, Anesthesiology operates independently with full editorial freedom. Its distinguished Editorial Board, comprising renowned professionals from across the globe, drives the advancement of the specialty by presenting innovative research through immediate open access to select articles and granting free access to all published articles after a six-month period. Furthermore, Anesthesiology actively promotes groundbreaking studies through an influential press release program. The journal's unwavering commitment lies in the dissemination of exemplary work that enhances clinical practice and revolutionizes the practice of medicine within our discipline.