Association of intraoperative hypotension with postoperative morbidity and mortality: systematic review and meta-analysis.

Autor:	Wijnberge M; Department of Anaesthesiology, Amsterdam University Medical Centre, Amsterdam, the Netherlands.; Department of Intensive Care, Amsterdam University Medical Centre, Amsterdam, the Netherlands.; Laboratory of Experimental Intensive Care and Anaesthesiology, Amsterdam University Medical Centre, Amsterdam, the Netherlands., Schenk J; Department of Anaesthesiology, Amsterdam University Medical Centre, Amsterdam, the Netherlands., Bulle E; Department of Anaesthesiology, Amsterdam University Medical Centre, Amsterdam, the Netherlands.; Department of Intensive Care, Amsterdam University Medical Centre, Amsterdam, the Netherlands., Vlaar AP; Department of Intensive Care, Amsterdam University Medical Centre, Amsterdam, the Netherlands.; Laboratory of Experimental Intensive Care and Anaesthesiology, Amsterdam University Medical Centre, Amsterdam, the Netherlands., Maheshwari K; Department of General Anaesthesiology, Outcomes Research, Anaesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA., Hollmann MW; Department of Anaesthesiology, Amsterdam University Medical Centre, Amsterdam, the Netherlands.; Laboratory of Experimental Intensive Care and Anaesthesiology, Amsterdam University Medical Centre, Amsterdam, the Netherlands., Binnekade JM; Department of Intensive Care, Amsterdam University Medical Centre, Amsterdam, the Netherlands., Geerts BF; Department of Anaesthesiology, Amsterdam University Medical Centre, Amsterdam, the Netherlands., Veelo DP; Department of Anaesthesiology, Amsterdam University Medical Centre, Amsterdam, the Netherlands.
Jazyk:	angličtina
Zdroj:	BJS open [BJS Open] 2021 Jan 08; Vol. 5 (1).
DOI:	10.1093/bjsopen/zraa018
Abstrakt:	Background: Intraoperative hypotension, with varying definitions in literature, may be associated with postoperative complications. The aim of this meta-analysis was to assess the association of intraoperative hypotension with postoperative morbidity and mortality. Methods: MEDLINE, Embase and Cochrane databases were searched for studies published between January 1990 and August 2018. The primary endpoints were postoperative overall morbidity and mortality. Secondary endpoints were postoperative cardiac outcomes, acute kidney injury, stroke, delirium, surgical outcomes and combined outcomes. Subgroup analyses, sensitivity analyses and a meta-regression were performed to test the robustness of the results and to explore heterogeneity. Results: The search identified 2931 studies, of which 29 were included in the meta-analysis, consisting of 130 862 patients. Intraoperative hypotension was associated with an increased risk of morbidity (odds ratio (OR) 2.08, 95 per cent confidence interval 1.56 to 2.77) and mortality (OR 1.94, 1.32 to 2.84). In the secondary analyses, intraoperative hypotension was associated with cardiac complications (OR 2.44, 1.52 to 3.93) and acute kidney injury (OR 2.69, 1.31 to 5.55). Overall heterogeneity was high, with an I2 value of 88 per cent. When hypotension severity, outcome severity and study population variables were added to the meta-regression, heterogeneity was reduced to 50 per cent. Conclusion: Intraoperative hypotension during non-cardiac surgery is associated with postoperative cardiac and renal morbidity, and mortality. A universally accepted standard definition of hypotension would facilitate further research into this topic. (© The Author(s) 2021. Published by Oxford University Press on behalf of BJS Society Ltd.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu