Intraoperative Hypotension and 1-Year Mortality after Noncardiac Surgery
Intraoperative hypotension (IOH) is frequently associated with adverse outcome such as 1-yr mortality. However, there is no consensus on the correct definition of IOH. The authors studied a number of different definitions of IOH, based on blood pressure thresholds and minimal episode durations, and...
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| Veröffentlicht in: | Anesthesiology (Philadelphia) 2009-12, Vol.111 (6), p.1217-1226 |
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| creator | BIJKER, Jilles B VAN KLEI, Wilton A VERGOUWE, Yvonne ELEVELD, Douglas J VAN WOLFSWINKEL, Leo MOONS, Karel G. M KALKMAN, CorJ |
| description | Intraoperative hypotension (IOH) is frequently associated with adverse outcome such as 1-yr mortality. However, there is no consensus on the correct definition of IOH. The authors studied a number of different definitions of IOH, based on blood pressure thresholds and minimal episode durations, and their association with 1-yr mortality after noncardiac surgery.
This cohort study included 1,705 consecutive adult patients who underwent general and vascular surgery. Data on IOH and potentially confounding variables were obtained from electronic record-keeping systems. Mortality data were collected up to 1 yr after surgery. The authors used two different techniques to reduce the influence of confounding variables, multivariable Cox proportional hazard regression modeling and classification and regression tree analysis.
The mortality within 1 yr after surgery was 5.2% (88 patients). After adjustment for confounding, the Cox regression analysis did not show an association between IOH and the risk of dying within 1 yr after surgery (hazard ratio around 1.00 with high P values for different definitions of IOH). Additional classification and regression tree analysis identified IOH as a predictor for 1-yr mortality in elderly patients. When the blood pressure threshold for IOH was decreased, the duration of IOH at which this association was found was decreased as well.
This observational study showed no causal relation between IOH and 1-yr mortality after noncardiac surgery for any of the definitions of IOH. Nevertheless, additional analysis suggested that for elderly patients, the mortality risk increases when the duration of IOH becomes long enough. The length of this duration depends on the designated blood pressure threshold, suggesting that lower blood pressures are tolerated for shorter durations. The effect of IOH on 1-yr mortality remains debatable, and no firm conclusions on the lowest acceptable intraoperative blood pressures can be drawn from this study. |
| doi_str_mv | 10.1097/aln.0b013e3181c14930 |
| format | Article |
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This cohort study included 1,705 consecutive adult patients who underwent general and vascular surgery. Data on IOH and potentially confounding variables were obtained from electronic record-keeping systems. Mortality data were collected up to 1 yr after surgery. The authors used two different techniques to reduce the influence of confounding variables, multivariable Cox proportional hazard regression modeling and classification and regression tree analysis.
The mortality within 1 yr after surgery was 5.2% (88 patients). After adjustment for confounding, the Cox regression analysis did not show an association between IOH and the risk of dying within 1 yr after surgery (hazard ratio around 1.00 with high P values for different definitions of IOH). Additional classification and regression tree analysis identified IOH as a predictor for 1-yr mortality in elderly patients. When the blood pressure threshold for IOH was decreased, the duration of IOH at which this association was found was decreased as well.
This observational study showed no causal relation between IOH and 1-yr mortality after noncardiac surgery for any of the definitions of IOH. Nevertheless, additional analysis suggested that for elderly patients, the mortality risk increases when the duration of IOH becomes long enough. The length of this duration depends on the designated blood pressure threshold, suggesting that lower blood pressures are tolerated for shorter durations. The effect of IOH on 1-yr mortality remains debatable, and no firm conclusions on the lowest acceptable intraoperative blood pressures can be drawn from this study.</description><identifier>ISSN: 0003-3022</identifier><identifier>EISSN: 1528-1175</identifier><identifier>DOI: 10.1097/aln.0b013e3181c14930</identifier><identifier>PMID: 19934864</identifier><identifier>CODEN: ANESAV</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Anesthesia ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Area Under Curve ; Biological and medical sciences ; Body Mass Index ; Cause of Death ; Cohort Studies ; Data Interpretation, Statistical ; Female ; Humans ; Hypotension - mortality ; Intraoperative Complications - physiopathology ; Kaplan-Meier Estimate ; Male ; Medical sciences ; Middle Aged ; Postoperative Period ; Proportional Hazards Models ; Regression Analysis ; Surgical Procedures, Operative ; Survival Analysis ; Treatment Outcome ; Vascular Surgical Procedures</subject><ispartof>Anesthesiology (Philadelphia), 2009-12, Vol.111 (6), p.1217-1226</ispartof><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c448t-60b22950fa8f327c2f14619f7a2dda8dca16e856b7f76aa321f46a2969d8169f3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,782,786,27933,27934</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=22194945$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19934864$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>BIJKER, Jilles B</creatorcontrib><creatorcontrib>VAN KLEI, Wilton A</creatorcontrib><creatorcontrib>VERGOUWE, Yvonne</creatorcontrib><creatorcontrib>ELEVELD, Douglas J</creatorcontrib><creatorcontrib>VAN WOLFSWINKEL, Leo</creatorcontrib><creatorcontrib>MOONS, Karel G. M</creatorcontrib><creatorcontrib>KALKMAN, CorJ</creatorcontrib><title>Intraoperative Hypotension and 1-Year Mortality after Noncardiac Surgery</title><title>Anesthesiology (Philadelphia)</title><addtitle>Anesthesiology</addtitle><description>Intraoperative hypotension (IOH) is frequently associated with adverse outcome such as 1-yr mortality. However, there is no consensus on the correct definition of IOH. The authors studied a number of different definitions of IOH, based on blood pressure thresholds and minimal episode durations, and their association with 1-yr mortality after noncardiac surgery.
This cohort study included 1,705 consecutive adult patients who underwent general and vascular surgery. Data on IOH and potentially confounding variables were obtained from electronic record-keeping systems. Mortality data were collected up to 1 yr after surgery. The authors used two different techniques to reduce the influence of confounding variables, multivariable Cox proportional hazard regression modeling and classification and regression tree analysis.
The mortality within 1 yr after surgery was 5.2% (88 patients). After adjustment for confounding, the Cox regression analysis did not show an association between IOH and the risk of dying within 1 yr after surgery (hazard ratio around 1.00 with high P values for different definitions of IOH). Additional classification and regression tree analysis identified IOH as a predictor for 1-yr mortality in elderly patients. When the blood pressure threshold for IOH was decreased, the duration of IOH at which this association was found was decreased as well.
This observational study showed no causal relation between IOH and 1-yr mortality after noncardiac surgery for any of the definitions of IOH. Nevertheless, additional analysis suggested that for elderly patients, the mortality risk increases when the duration of IOH becomes long enough. The length of this duration depends on the designated blood pressure threshold, suggesting that lower blood pressures are tolerated for shorter durations. The effect of IOH on 1-yr mortality remains debatable, and no firm conclusions on the lowest acceptable intraoperative blood pressures can be drawn from this study.</description><subject>Anesthesia</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Area Under Curve</subject><subject>Biological and medical sciences</subject><subject>Body Mass Index</subject><subject>Cause of Death</subject><subject>Cohort Studies</subject><subject>Data Interpretation, Statistical</subject><subject>Female</subject><subject>Humans</subject><subject>Hypotension - mortality</subject><subject>Intraoperative Complications - physiopathology</subject><subject>Kaplan-Meier Estimate</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Postoperative Period</subject><subject>Proportional Hazards Models</subject><subject>Regression Analysis</subject><subject>Surgical Procedures, Operative</subject><subject>Survival Analysis</subject><subject>Treatment Outcome</subject><subject>Vascular Surgical Procedures</subject><issn>0003-3022</issn><issn>1528-1175</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkFFLwzAUhYMobk7_gUhfxKfO3CRNk8cx1A3mfFAffCq3aSKVrp1JK_TfW1lR8Oly4DvnwkfIJdA5UJ3eYlXPaU6BWw4KDAjN6RGZQsJUDJAmx2RKKeUxp4xNyFkIH0NME65OyQS05kJJMSWrdd16bPbWY1t-2WjV75vW1qFs6gjrIoL4zaKPHhvfYlW2fYSutT7aNrVBX5RooufOv1vfn5MTh1WwF-Odkdf7u5flKt48PayXi01shFBtLGnOmE6oQ-U4Sw1zICRolyIrClSFQZBWJTJPXSoROQMnJDItdaFAasdn5Oawu_fNZ2dDm-3KYGxVYW2bLmQp55ImkouBFAfS-CYEb1229-UOfZ8BzX4UZovNNvuvcKhdjQ-6fGeLv9LobACuRwCDwcp5rE0ZfjnGQAstEv4Nj_V6Mg</recordid><startdate>20091201</startdate><enddate>20091201</enddate><creator>BIJKER, Jilles B</creator><creator>VAN KLEI, Wilton A</creator><creator>VERGOUWE, Yvonne</creator><creator>ELEVELD, Douglas J</creator><creator>VAN WOLFSWINKEL, Leo</creator><creator>MOONS, Karel G. M</creator><creator>KALKMAN, CorJ</creator><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20091201</creationdate><title>Intraoperative Hypotension and 1-Year Mortality after Noncardiac Surgery</title><author>BIJKER, Jilles B ; VAN KLEI, Wilton A ; VERGOUWE, Yvonne ; ELEVELD, Douglas J ; VAN WOLFSWINKEL, Leo ; MOONS, Karel G. M ; KALKMAN, CorJ</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c448t-60b22950fa8f327c2f14619f7a2dda8dca16e856b7f76aa321f46a2969d8169f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Anesthesia</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Area Under Curve</topic><topic>Biological and medical sciences</topic><topic>Body Mass Index</topic><topic>Cause of Death</topic><topic>Cohort Studies</topic><topic>Data Interpretation, Statistical</topic><topic>Female</topic><topic>Humans</topic><topic>Hypotension - mortality</topic><topic>Intraoperative Complications - physiopathology</topic><topic>Kaplan-Meier Estimate</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Postoperative Period</topic><topic>Proportional Hazards Models</topic><topic>Regression Analysis</topic><topic>Surgical Procedures, Operative</topic><topic>Survival Analysis</topic><topic>Treatment Outcome</topic><topic>Vascular Surgical Procedures</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>BIJKER, Jilles B</creatorcontrib><creatorcontrib>VAN KLEI, Wilton A</creatorcontrib><creatorcontrib>VERGOUWE, Yvonne</creatorcontrib><creatorcontrib>ELEVELD, Douglas J</creatorcontrib><creatorcontrib>VAN WOLFSWINKEL, Leo</creatorcontrib><creatorcontrib>MOONS, Karel G. M</creatorcontrib><creatorcontrib>KALKMAN, CorJ</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Anesthesiology (Philadelphia)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>BIJKER, Jilles B</au><au>VAN KLEI, Wilton A</au><au>VERGOUWE, Yvonne</au><au>ELEVELD, Douglas J</au><au>VAN WOLFSWINKEL, Leo</au><au>MOONS, Karel G. M</au><au>KALKMAN, CorJ</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Intraoperative Hypotension and 1-Year Mortality after Noncardiac Surgery</atitle><jtitle>Anesthesiology (Philadelphia)</jtitle><addtitle>Anesthesiology</addtitle><date>2009-12-01</date><risdate>2009</risdate><volume>111</volume><issue>6</issue><spage>1217</spage><epage>1226</epage><pages>1217-1226</pages><issn>0003-3022</issn><eissn>1528-1175</eissn><coden>ANESAV</coden><abstract>Intraoperative hypotension (IOH) is frequently associated with adverse outcome such as 1-yr mortality. However, there is no consensus on the correct definition of IOH. The authors studied a number of different definitions of IOH, based on blood pressure thresholds and minimal episode durations, and their association with 1-yr mortality after noncardiac surgery.
This cohort study included 1,705 consecutive adult patients who underwent general and vascular surgery. Data on IOH and potentially confounding variables were obtained from electronic record-keeping systems. Mortality data were collected up to 1 yr after surgery. The authors used two different techniques to reduce the influence of confounding variables, multivariable Cox proportional hazard regression modeling and classification and regression tree analysis.
The mortality within 1 yr after surgery was 5.2% (88 patients). After adjustment for confounding, the Cox regression analysis did not show an association between IOH and the risk of dying within 1 yr after surgery (hazard ratio around 1.00 with high P values for different definitions of IOH). Additional classification and regression tree analysis identified IOH as a predictor for 1-yr mortality in elderly patients. When the blood pressure threshold for IOH was decreased, the duration of IOH at which this association was found was decreased as well.
This observational study showed no causal relation between IOH and 1-yr mortality after noncardiac surgery for any of the definitions of IOH. Nevertheless, additional analysis suggested that for elderly patients, the mortality risk increases when the duration of IOH becomes long enough. The length of this duration depends on the designated blood pressure threshold, suggesting that lower blood pressures are tolerated for shorter durations. The effect of IOH on 1-yr mortality remains debatable, and no firm conclusions on the lowest acceptable intraoperative blood pressures can be drawn from this study.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>19934864</pmid><doi>10.1097/aln.0b013e3181c14930</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Anesthesia Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Area Under Curve Biological and medical sciences Body Mass Index Cause of Death Cohort Studies Data Interpretation, Statistical Female Humans Hypotension - mortality Intraoperative Complications - physiopathology Kaplan-Meier Estimate Male Medical sciences Middle Aged Postoperative Period Proportional Hazards Models Regression Analysis Surgical Procedures, Operative Survival Analysis Treatment Outcome Vascular Surgical Procedures |
| title | Intraoperative Hypotension and 1-Year Mortality after Noncardiac Surgery |
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