Intraoperative hypotension and postoperative risks in non-cardiac surgery: a meta-analysis

Area of Science:

• Anesthesiology and Critical Care Medicine
• Surgical Outcomes Research

Background:

• Intraoperative hypotension is linked to postoperative complications, but optimal management strategies are debated.
• Defining treatment thresholds for intraoperative hypotension is crucial for patient outcomes.
• This study addresses the controversy surrounding the management of intraoperative hypotension.

Purpose of the Study:

• To compare the incidence of postoperative complications using different treatment thresholds for intraoperative hypotension.
• To evaluate the impact of mean arterial pressure management on patient outcomes.
• To synthesize evidence from randomized controlled trials on hypotension management.

Main Methods:

• A meta-analysis of randomized controlled trials (RCTs) published between 2014-2024.
• Searched PubMed, Cochrane Database, and Embase for relevant studies.
• Included RCTs on non-cardiac, non-obstetric surgery comparing hypotension treatment thresholds (low, moderate, high MAP).
• Primary outcomes: postoperative complications (e.g., acute kidney injury); Secondary outcomes: length of stay, all-cause mortality.

Main Results:

• Eight RCTs with 9108 participants were included in the meta-analysis.
• No significant difference in postoperative complications was found between moderate and high mean arterial pressure (MAP) treatment thresholds.
• Length of hospitalization did not significantly differ between the moderate and high MAP groups.

Conclusions:

• Current evidence suggests no significant difference in postoperative complications between moderate and high MAP management.
• Further research is needed to analyze lower treatment thresholds for intraoperative hypotension.
• Optimizing intraoperative hypotension management requires continued investigation.