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Open AccessArticle

Intraoperative Blood Pressure Variability Predicts Postoperative Mortality in Non-Cardiac Surgery—A Prospective Observational Cohort Study

Department of Anaesthesiology and Intensive Care, School of Medicine in Katowice, Medical University of Silesia, 14 Medyków Street, 40-752 Katowice, Poland
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Int. J. Environ. Res. Public Health 2019, 16(22), 4380; https://doi.org/10.3390/ijerph16224380
Received: 16 September 2019 / Revised: 29 October 2019 / Accepted: 6 November 2019 / Published: 9 November 2019
(This article belongs to the Section Global Health)
Little is known about the clinical importance of blood pressure variability (BPV) during anesthesia in non-cardiac surgery. We sought to investigate the impact of intraoperative BPV on postoperative mortality in non-cardiac surgery subjects, taking into account patient- and procedure-related variables. This prospective observational study covered 835 randomly selected patients who underwent gastrointestinal (n = 221), gynecological (n = 368) and neurosurgical (n = 246) procedures. Patient’s and procedure’s risks were assessed according to the validated tools and guidelines. Blood pressure (systolic, SBP, and diastolic, DBP) was recorded in five-minute intervals during anesthesia. Mean arterial pressure (MAP) was assessed. Individual coefficients of variation (Cv) were calculated. Postoperative 30-day mortality was considered the outcome. Median SBP_Cv was 11.2% (IQR 8.4–14.6), DBP_Cv was 12.7% (IQR 9.8–16.3) and MAP_Cv was 10.96% (IQR 8.26–13.86). Mortality was 2%. High SBP_Cv (i.e., ≥11.9%) was associated with increased mortality by 4.5 times (OR = 4.55; 95% CI 1.48–13.93; p = 0.008). High DBP_Cv (i.e., ≥22.4%) was associated with increased mortality by nearly 10 times (OR = 9.73; 95% CI 3.26–28.99; p < 0.001). High MAP_Cv (i.e., ≥13.6%) was associated with increased mortality by 3.5 times (OR = 3.44; 95% CI 1.34–8.83; p = 0.01). In logistic regression, it was confirmed that the outcome was dependent on both SBPV and DBPV, after adjustment for perioperative variables, with AUCSBP_Cv = 0.884 (95% CI 0.859–0.906; p < 0.001) and AUCDBP_Cv = 0.897 (95% CI 0.873–0.918; p < 0.001). Therefore, intraoperative BPV may be considered a prognostic factor for the postoperative mortality in non-cardiac surgery, and DBPV seems more accurate in outcome prediction than SBPV. View Full-Text
Keywords: blood pressure variability; intraoperative monitoring; postoperative mortality; non-cardiac surgery blood pressure variability; intraoperative monitoring; postoperative mortality; non-cardiac surgery
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Wiórek, A.; Krzych, Ł.J. Intraoperative Blood Pressure Variability Predicts Postoperative Mortality in Non-Cardiac Surgery—A Prospective Observational Cohort Study. Int. J. Environ. Res. Public Health 2019, 16, 4380.

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