Effect of Intraoperative Blood Pressure Levels on Postoperative Recovery in Frail Elderly Patients: A Randomized...

Frailty is a clinical syndrome characterized by a reduction in the functional capacity of multiple physiological systems, which increases the body's vulnerability to stressors and reduces the capacity of elderly patients to recover from stressful events such as anesthesia and surgery.

A total of 142 elderly frailty patients scheduled for total knee arthroplasty were randomly assigned to either the low-level (Group L) or high-level group (Group H). Group L maintained intraoperative mean arterial pressure (MAP) at 65-85 mmHg, while Group H targeted 85-100 mmHg. The primary outcome was the Quality of Recovery-15 (QoR-15) score on postoperative day (POD) 1. Secondary outcomes include the time-weighted average mean arterial pressure (TWA-MAP) intraoperatively, QoR-15 scores on POD2-5, the abbreviated mental test score (AMTS) at 30 days and 1-year postoperatively, the incidence of myocardial injury after noncardiac surgery (MINS) and acute kidney injury (AKI), 1-year mortality postoperatively.

There was no significant difference in QoR-15 values on POD1 between Group L and Group H (mean [SD] 99 [9.89] vs 98 [12.82], mean difference 95% confidence interval (CI) 0.91 (-3.08-4.91)). TWA-MAP was 93.1 ± 2.29 mmHg in Group H and 78.6 ± 2.97 mmHg in Group L (P < 0.05, mean difference 95% CI -14.5 (-15.4, -13.6)), indicating a statistically significant difference between the two groups.

Maintaining higher or lower MAP intraoperatively had no significant effect on the quality of postoperative recovery in elderly frailty patients undergoing knee arthroplasty under the conditions studied in this trial.