Association Between Intraoperative Arterial Hypotension and Postoperative Delirium After Noncardiac Surgery: A Retrospective Multicenter Cohort Study
- PMID: 34517389
- DOI: 10.1213/ANE.0000000000005739
Association Between Intraoperative Arterial Hypotension and Postoperative Delirium After Noncardiac Surgery: A Retrospective Multicenter Cohort Study
Abstract
Background: It is unclear whether intraoperative arterial hypotension is associated with postoperative delirium. We hypothesized that intraoperative hypotension within a range frequently observed in clinical practice is associated with increased odds of delirium after surgery.
Methods: Adult noncardiac surgical patients undergoing general anesthesia at 2 academic medical centers between 2005 and 2017 were included in this retrospective cohort study. The primary exposure was intraoperative hypotension, defined as the cumulative duration of an intraoperative mean arterial pressure (MAP) <55 mm Hg, categorized into and short (<15 minutes; median [interquartile range {IQR}], 2 [1-4] minutes) and prolonged (≥15 minutes; median [IQR], 21 [17-31] minutes) durations of intraoperative hypotension. The primary outcome was a new diagnosis of delirium within 30 days after surgery. In secondary analyses, we assessed the association between a MAP decrease of >30% from baseline and postoperative delirium. Multivariable logistic regression adjusted for patient- and procedure-related factors, including demographics, comorbidities, and markers of procedural severity, was used.
Results: Among 316,717 included surgical patients, 2183 (0.7%) were diagnosed with delirium within 30 days after surgery; 41.7% and 2.6% of patients had a MAP <55 mm Hg for a short and a prolonged duration, respectively. A MAP <55 mm Hg was associated with postoperative delirium compared to no hypotension (short duration of MAP <55 mm Hg: adjusted odds ratio [ORadj], 1.22; 95% confidence interval [CI], 1.11-1.33; P < .001 and prolonged duration of MAP <55 mm Hg: ORadj, 1.57; 95% CI, 1.27-1.94; P < .001). Compared to a short duration of a MAP <55 mm Hg, a prolonged duration of a MAP <55 mm Hg was associated with greater odds of postoperative delirium (ORadj, 1.29; 95% CI, 1.05-1.58; P = .016). The association between intraoperative hypotension and postoperative delirium was duration-dependent (ORadj for every 10 cumulative minutes of MAP <55 mm Hg: 1.06; 95% CI, 1.02-1.09; P =.001) and magnified in patients who underwent surgeries of longer duration (P for interaction = .046; MAP <55 mm Hg versus no MAP <55 mm Hg in patients undergoing surgery of >3 hours: ORadj, 1.40; 95% CI, 1.23-1.61; P < .001). A MAP decrease of >30% from baseline was not associated with postoperative delirium compared to no hypotension, also when additionally adjusted for the cumulative duration of a MAP <55 mm Hg (short duration of MAP decrease >30%: ORadj, 1.13; 95% CI, 0.91-1.40; P = .262 and prolonged duration of MAP decrease >30%: ORadj, 1.19; 95% CI, 0.95-1.49; P = .141).
Conclusions: In patients undergoing noncardiac surgery, a MAP <55 mm Hg was associated with a duration-dependent increase in odds of postoperative delirium. This association was magnified in patients who underwent surgery of long duration.
Copyright © 2021 International Anesthesia Research Society.
Conflict of interest statement
Conflicts of Interest: See Disclosures at the end of the article.
Similar articles
-
Intraoperative hypotension and postoperative outcomes: a meta-analysis of randomised trials.Br J Anaesth. 2023 Nov;131(5):823-831. doi: 10.1016/j.bja.2023.08.026. Epub 2023 Sep 20. Br J Anaesth. 2023. PMID: 37739903 Review.
-
Reported definitions of intraoperative hypotension in adults undergoing non-cardiac surgery under general anaesthesia: a review.BMC Anesthesiol. 2022 Mar 11;22(1):69. doi: 10.1186/s12871-022-01605-9. BMC Anesthesiol. 2022. PMID: 35277122 Free PMC article. Review.
-
Effect of Intraoperative Arterial Hypotension on the Risk of Perioperative Stroke After Noncardiac Surgery: A Retrospective Multicenter Cohort Study.Anesth Analg. 2021 Oct 1;133(4):1000-1008. doi: 10.1213/ANE.0000000000005604. Anesth Analg. 2021. PMID: 34252055
-
Intraoperative Hypotension Is Associated With Adverse Clinical Outcomes After Noncardiac Surgery.Anesth Analg. 2021 Jun 1;132(6):1654-1665. doi: 10.1213/ANE.0000000000005250. Anesth Analg. 2021. PMID: 33177322 Free PMC article.
-
Effect of a Machine Learning-Derived Early Warning System for Intraoperative Hypotension vs Standard Care on Depth and Duration of Intraoperative Hypotension During Elective Noncardiac Surgery: The HYPE Randomized Clinical Trial.JAMA. 2020 Mar 17;323(11):1052-1060. doi: 10.1001/jama.2020.0592. JAMA. 2020. PMID: 32065827 Free PMC article. Clinical Trial.
Cited by
-
Is research reporting intraoperative hypotension apt enough?Indian J Anaesth. 2024 May;68(5):496-499. doi: 10.4103/ija.ija_209_24. Epub 2024 Apr 12. Indian J Anaesth. 2024. PMID: 38764962 Free PMC article. No abstract available.
-
Comparison of Remimazolam and Propofol on Postoperative Delirium in Elderly Patients Undergoing Radical Resection of Colon Cancer: A Single-Center Prospective Randomized Controlled Study.Med Sci Monit. 2024 Apr 10;30:e943784. doi: 10.12659/MSM.943784. Med Sci Monit. 2024. PMID: 38594896 Free PMC article. Clinical Trial.
-
Effectiveness of remimazolam in preventing postoperative delirium in elderly patients with proximal femoral fractures.J Anesth. 2024 Mar 26. doi: 10.1007/s00540-024-03339-z. Online ahead of print. J Anesth. 2024. PMID: 38530454
-
The Effect of Ciprofol on Postoperative Delirium in Elderly Patients Undergoing Thoracoscopic Surgery for Lung Cancer: A Prospective, Randomized, Controlled Trial.Drug Des Devel Ther. 2024 Feb 5;18:325-339. doi: 10.2147/DDDT.S441950. eCollection 2024. Drug Des Devel Ther. 2024. PMID: 38344256 Free PMC article. Clinical Trial.
-
Bibliometric and visual analysis of intraoperative hypotension from 2004 to 2022.Front Cardiovasc Med. 2023 Nov 16;10:1270694. doi: 10.3389/fcvm.2023.1270694. eCollection 2023. Front Cardiovasc Med. 2023. PMID: 38045917 Free PMC article.
References
-
- Jin Z, Hu J, Ma D. Postoperative delirium: perioperative assessment, risk reduction, and management. Br J Anaesth. 2020;125:492–504.
-
- Leslie DL, Marcantonio ER, Zhang Y, Leo-Summers L, Inouye SK. One-year health care costs associated with delirium in the elderly population. Arch Intern Med. 2008;168:27–32.
-
- Brown CH 4th, Laflam A, Max L, et al. The impact of delirium after cardiac surgical procedures on postoperative resource use. Ann Thorac Surg. 2016;101:1663–1669.
-
- Guenther U, Hoffmann F, Dewald O, et al. Preoperative cognitive impairment and postoperative delirium predict decline in activities of daily living after cardiac surgery—a prospective, observational cohort study. Geriatrics. 2020;5:69.
-
- Evered LA, Silbert BS. Postoperative cognitive dysfunction and noncardiac surgery. Anesth Analg. 2018;127:496–505.
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Medical