Can routine perioperative haemodynamic parameters predict postoperative morbidity after major surgery?

Autor: Donal J. Buggy, Barbara Cusack, Jean-Francois Bonnet, Eleanor Buggy, Aislinn Sherwin, Tom Wall, Maria Fitzgibbon
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Zdroj: Perioperative Medicine, Vol 9, Iss 1, Pp 1-9 (2020)
Perioperative Medicine
ISSN: 2047-0525
Popis: Background Postoperative morbidity occurs in 10–15% of patients undergoing major noncardiac surgery. Predicting patients at higher risk of morbidity may help to optimize perioperative prevention. Preoperative haemodynamic parameters, systolic arterial pressure (SAP) 62 mmHg or 87 min-1 are associated with increased postoperative morbidity. We evaluated the correlation between these and other routine haemodynamic parameters, measured intraoperatively, with postoperative morbidity. Postoperative morbidity was measured using the Comprehensive Complication Index (CCI) and length of stay (LOS). Additionally we correlated CCI with the cardiac risk biomarker, preoperative NT-ProBNP. Methods This is a retrospective analysis of patients in MET-REPAIR, a European observational study correlating self-reported physical activity with postoperative morbidity. Patients’ electronic anaesthetic records (EARs) including perioperative haemodynamic data were correlated with 30-day postoperative morbidity, CCI and LOS parameters. Statistical analysis to assess for correlation was by Kendall’s Correlation Coefficient for tied ranks (Tau-B) or Spearman’s Correlation Coefficient. Blood for N-terminal prohormone of brain natriuretic peptide (NT-proBNP) measurement was collected Results Data from n = 50 patients were analysed. When stratified according to age > 70 years and ASA > 3, the duration of MAP p = 0.001) and duration p = 0.02). The intraoperative duration of PP > 62 mmHg was associated with LOS (tau = 0.317, p = 0.007). There was no correlation between preoperative NT-proBNP and either CCI or LOS. Conclusions In older and higher risk patients, duration of intraoperative hypotension by a variety of definitions, or PP > 62 mmHg, are associated with increased postoperative CCI and LOS. These findings warrant confirmation in larger databases with evaluation of whether real-time intraoperative intervention could reduce postoperative morbidity.
Databáze: OpenAIRE
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