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Relation between elevated first SBP from baseline (delta SBP) and postoperative outcome
Yan Zhou1, Lin Liu2, Fangfang Fan2
1Department of Anesthesiology and Critical Care Medicine.
Insights
Elevated blood pressure in the operating room, even with normal resting blood pressure, increases cardiovascular risk. A systolic blood pressure (SBP) increase over 49 mmHg during surgery is linked to major adverse cardiac events (MACE).
Area of Science:
- Cardiology
- Anesthesiology
- Perioperative Medicine
Background:
- Hypertension is a known risk factor for adverse postoperative outcomes.
- The specific risk associated with intraoperative blood pressure elevation in patients with normal resting blood pressure remains unclear.
Purpose of the Study:
- To investigate the relationship between the change in systolic blood pressure (delta SBP) from baseline to the operating room and the incidence of postoperative major adverse cardiac events (MACE).
- To identify a potential threshold for delta SBP that independently predicts MACE in patients with normal baseline blood pressure undergoing noncardiac surgery.
Main Methods:
- Retrospective cohort study of 55,563 patients undergoing elective noncardiac surgery.
- Analysis of the difference between first operating room SBP and baseline SBP (delta SBP).
- Multivariate logistic regression and propensity score weighting to assess the association between delta SBP and MACE.
Main Results:
- Postoperative MACE occurred in 4.1% of surgeries.
- A delta SBP threshold of 49 mmHg was identified.
- An increase in SBP over 49 mmHg was significantly associated with increased MACE risk (adjusted OR 1.35; P < 0.001).
Conclusions:
- Intraoperative systolic blood pressure increase independently contributes to elevated postoperative cardiovascular risk.
- A rise in SBP exceeding 49 mmHg from baseline during surgery is a significant predictor of MACE in patients undergoing elective noncardiac procedures.
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.
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