Can routine perioperative haemodynamic parameters predict postoperative morbidity after major surgery?

Area of Science:

• Anesthesiology
• Perioperative Medicine
• Critical Care

Background:

• Postoperative morbidity affects 10-15% of patients undergoing major noncardiac surgery.
• Preoperative hemodynamic parameters like low systolic arterial pressure (SAP), wide or narrow pulse pressure (PP), and high heart rate (HR) are linked to increased postoperative complications.
• Optimizing perioperative prevention requires accurate prediction of high-risk patients.

Purpose of the Study:

• To evaluate the correlation between intraoperative hemodynamic parameters and postoperative morbidity.
• To assess the relationship between routine hemodynamic measurements and postoperative outcomes, including the Comprehensive Complication Index (CCI) and length of stay (LOS).
• To investigate the correlation between preoperative NT-proBNP levels and postoperative morbidity.

Main Methods:

• Retrospective analysis of 50 patients from the MET-REPAIR observational study.
• Correlation of electronic anesthetic records (EARs) with 30-day postoperative morbidity, CCI, and LOS.
• Statistical analysis using Kendall's Tau-B or Spearman's Correlation Coefficient; NT-proBNP measured within 31 days pre-surgery.

Main Results:

• In patients >70 years and ASA > 3, duration of mean arterial pressure (MAP) < 100, < 75, or < 55 mmHg correlated with higher CCI.
• Duration of MAP < 75 mmHg was associated with prolonged LOS.
• Intraoperative PP > 62 mmHg correlated with increased LOS; no correlation found between NT-proBNP and CCI or LOS.

Conclusions:

• Intraoperative hypotension and PP > 62 mmHg are associated with increased postoperative CCI and LOS in older, high-risk surgical patients.
• These hemodynamic parameters serve as potential indicators for postoperative morbidity.
• Further validation in larger cohorts is needed to explore real-time intraoperative interventions for reducing postoperative complications.