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

Postoperative complications are often associated with the severity and duration of intraoperative hypotension. However, the optimal approach for managing intraoperative hypotension remains controversial. The aim of this meta-analysis of randomized controlled trials was to compare the incidence of common postoperative complications with different treatment threshold of hypotension.

We searched PubMed, the Cochrane Database, and Embase from August 2014 to August 2024 for studies comparing different treatment threshold of hypotension (low [mean arterial pressure < 60 mmHg], moderate [60-75 mmHg], and high [> 75 mmHg]). Only randomized controlled trials conducted during 2014-2024 were included in this meta-analysis without language restrictions. Studies with the following characteristics were included: randomized controlled study; involved non-cardiac, non-obstetric surgery; included different blood pressure management strategies; evaluated major postoperative complications; and included acute kidney injury, myocardial injury, altered consciousness, or infection. Data included patient age, type of surgery, group criteria, and adverse events. Mantel-Haenszel method was used for analysis. The primary outcomes were postoperative complications, including acute kidney injury. The secondary outcomes included length of hospital stay and all-cause mortality.

Of the 2160 studies identified, eight randomized controlled trials with 9108 participants were included. No significant differences in postoperative complications were observed between the moderate and high mean arterial pressure treatment threshold groups (risk ratio = 1.0, 95% confidence interval = 0.86-1.18, P = 0.96). Sensitivity analysis confirmed these findings. Length of hospitalization was not significantly different between the groups (standardized mean difference = -0.39; 95% confidence interval = -0.69 to 1.31; P = 0.03). Limited data prevented meta-analysis of mean arterial pressure management at lower treatment thresholds.

The results of this meta-analysis suggest no significant differences in postoperative complications between moderate and high mean arterial pressure management.