Risk factors for intraoperative hypotension during cardiac surgery

Intraoperative hypotension (IOH), a common adverse effect of general anesthesia, is influenced by multiple preoperative factors and may lead to unfavorable outcomes. This study investigates IOH and identifies risk factors contributing to its occurrence during cardiac surgery.

This prospective, single-center study was conducted over one year and included patients undergoing cardiac surgery. Preoperative data, including demographic characteristics, comorbidities, chronic cardiovascular therapy, and their impact on IOH, were recorded. Risk factors for IOH were identified using multivariable binary logistic regression analysis.

The IOH group consisted of 182 patients (31.5%), while the control group (without IOH) included 395 patients (68.5%). The total cohort comprised 402 men (69.7%) and 175 women (30.3%), with a mean age of 66.75 ± 9.24 years. The following preoperative factors were identified as significant risk factors for IOH: advanced age (Odds ratio [OR] 1.038, 95% confidence interval [CI] 1.013-1.063; p = 0.002), previous heart failure (OR 5.022, 95% CI 2.478-10.180; p < 0.0005), atrial fibrillation (OR 1.971, 95% CI 1.256-3.093; p = 0.003), chronic kidney disease (OR 2.256, 95% CI 1.064-4.784; p = 0.034), cerebrovascular accident (OR 2.493, 95% CI 1.208-5.144; p = 0.013), and anemia (OR 2.031, 95% CI 1.060-4.008; p = 0.010). Patients classified as ASA IV had a significantly higher risk of IOH compared to those with an ASA III score (OR 3.035, 95% CI 1.256-7.332; p = 0.014).

Older age, previous heart failure, atrial fibrillation, chronic kidney disease, cerebrovascular accident, anemia, and a higher ASA score (ASA IV) were identified as significant preoperative risk factors for intraoperative hypotension.

The online version contains supplementary material available at 10.1007/s12055-025-01961-4.