Intraoperative hypotension in ambulatory surgery centers

Area of Science:

• Anesthesiology
• Surgical Outcomes
• Health Services Research

Background:

• Intraoperative hypotension (IOH) is a critical concern during surgical procedures.
• Understanding IOH incidence in Ambulatory Surgery Centers (ASCs) is essential for patient safety.
• Previous literature has primarily focused on IOH in hospital settings.

Purpose of the Study:

• To measure the incidence of intraoperative hypotension (IOH) in ambulatory surgery centers (ASCs).
• To describe patient and procedural characteristics associated with IOH in ASCs.
• To compare IOH incidence in ASCs with findings from academic hospital settings.

Main Methods:

• Retrospective analysis of 16,750 patients undergoing non-emergent, non-cardiac surgery in 20 ASCs.
• IOH was defined as mean arterial pressure (MAP) <65 mmHg for at least 15 cumulative minutes, per CMS MIPS criteria.
• Secondary definitions included minutes of MAP <65 mmHg, area under MAP of 65 mmHg, and time-weighted average MAP <65 mmHg.

Main Results:

• 30.9% of cases experienced IOH (MAP <65 mmHg for ≥15 min).
• Higher IOH incidence was observed in younger adults (18-39 years; 36.2%), females (35.2%), and ASA physical status 2 patients (32.8%).
• IOH increased with surgery length and was highest in high-complexity procedures (44.1%).

Conclusions:

• A substantial occurrence of IOH was found in ASCs, comparable to hospital settings.
• Hypotheses suggest potential clinician under-intervention or assumptions about patient tolerance.
• Further research is needed to determine if IOH in ASCs is associated with adverse outcomes similar to hospital-based surgeries.