Incidence and Risk Factors for Severe Postoperative Hypotension in General Care Wards

To determine the incidence and predictors of severe postoperative hypotension (SPOH) among patients in general care wards.

We performed a retrospective study of adult patients who underwent general anesthesia at Mayo Clinic between May 5, 2018, and December 31, 2020, and were discharged from the postanesthesia care unit (PACU) to general care wards. Multivariable logistic regression models were used to identify potential predictors of SPOH (defined as mean arterial pressure [MAP] ≤55 mm Hg within 48 hours after a surgical procedure that resulted in rapid response team activation or advanced interventions).

Among 23,656 eligible patients, 172 (0.7%; 95% CI, 0.6-0.9) had SPOH. Independent predictors included lower body mass index (OR, 0.83 per 5-unit increase; 95% CI, 0.73-0.95; P=.006), longer procedure duration (OR, 1.14 per 1 hour; 95% CI, 1.07-1.22; P<.001), and intraoperative blood transfusion (OR, 4.32; 95% CI, 2.92-6.38; P<.001). A significant interaction was observed between preoperative and lowest PACU MAPs (P=.04); SPOH risk was highest for patients with low preoperative and PACU MAPs. Patients with a preoperative MAP of 70 mm Hg or less and a PACU MAP of 60 mm Hg or less had 9.84-fold higher odds of SPOH (reference, 93.3 mm Hg).

Lower preoperative and PACU MAPs are associated with higher odds of SPOH. These findings highlight the need for greater postoperative surveillance of surgical patients with low perioperative blood pressure.