Saasouh Wael, Christensen Anna L, Xing Fei, Chappell Desirée, Lumbley Josh, Woods Brian, Mythen Monty, Dutton Richard P
Department of Anesthesiology, Detroit Medical Center, Detroit, MI, USA.
NorthStar Anesthesia, Irving, TX, USA.
Perioper Med (Lond). 2023 Jun 24;12(1):29. doi: 10.1186/s13741-023-00318-y.
Intraoperative hypotension (IOH) is well-described in the academic setting but not in community practice. IOH is associated with risk of postoperative morbidity and mortality. This is the first report of IOH in the community setting using the IOH measure definition from the Centers for Medicare and Medicaid Services Merit-based Incentive Payment System program.
To describe the incidence of IOH in the community setting; assess variation in IOH by patient-, procedure-, and facility-level characteristics; and describe variation in risk-adjusted IOH across clinicians.
Design Cross-sectional descriptive analysis of retrospective data from anesthesia records in 2020 and 2021. Setting Forty-five facilities affiliated with two large anesthesia providers in the USA. Participants Patients aged 18 years or older having non-emergent, non-cardiac surgery under general, neuraxial, or regional anesthesia. Cases were excluded based on criteria for the IOH measure: baseline mean arterial pressure (MAP) below 65 mmHg prior to anesthesia induction; American Society of Anesthesiologists (ASA) physical status classification of I, V, or VI; monitored anesthesia care only; deliberate induced hypotension; obstetric non-operative procedures; liver or lung transplant; cataract surgery; non-invasive gastrointestinal cases. Main outcomes IOH, using four definitions. Primary definition: binary assessment of whether the case had MAP < 65 mmHg for 15 min or more. Secondary definitions: total number of minutes of MAP < 65 mmHg, total area under MAP of 65 mmHg, time-weighted average MAP < 65 mmHg.
Among 127,095 non-emergent, non-cardiac cases in community anesthesia settings, 29% had MAP < 65 mmHg for at least 15 min cumulatively, with an overall mean of 12.4 min < 65 mmHg. IOH was slightly more common in patients who were younger, female, and ASA II (versus III or IV); in procedures that were longer and had higher anesthesia base units; and in ambulatory surgery centers. Incidence of IOH varied widely across individual clinicians in both unadjusted and risk-adjusted analyses.
Intraoperative hypotension is common in community anesthesia practice, including among patients and settings typically considered "low risk." Variation in incidence across clinicians remains after risk-adjustment, suggesting that IOH is a modifiable risk worth pursuing in quality improvement initiatives.
术中低血压（IOH）在学术环境中已有充分描述，但在社区实践中却并非如此。IOH与术后发病和死亡风险相关。这是在社区环境中使用医疗保险和医疗补助服务中心基于绩效的激励支付系统计划中的IOH测量定义对IOH进行的首次报告。
描述社区环境中IOH的发生率；评估按患者、手术和机构层面特征划分的IOH差异；并描述不同临床医生之间经风险调整后的IOH差异。
对2020年和2021年麻醉记录中的回顾性数据进行横断面描述性分析。地点：美国两家大型麻醉服务提供商下属的45个机构。参与者：年龄在18岁及以上、接受全身麻醉、神经轴麻醉或区域麻醉下非急诊、非心脏手术的患者。根据IOH测量标准排除病例：麻醉诱导前基线平均动脉压（MAP）低于65mmHg；美国麻醉医师协会（ASA）身体状况分级为I、V或VI；仅接受监护麻醉；故意诱导低血压；产科非手术程序；肝或肺移植；白内障手术；非侵入性胃肠道病例。主要结局：使用四种定义的IOH。主要定义：病例的MAP是否低于65mmHg达15分钟或更长时间的二元评估。次要定义：MAP低于65mmHg的总分钟数、MAP低于65mmHg的总面积、时间加权平均MAP低于65mmHg。
在社区麻醉环境中的127,095例非急诊、非心脏病例中，29%的患者累计有至少15分钟的MAP低于65mmHg，总体平均低于65mmHg的时间为12.4分钟。IOH在年龄较小、女性和ASA II级（相对于III级或IV级）的患者中略为常见；在手术时间较长且麻醉基本单位较高的手术中；以及在门诊手术中心。在未调整和风险调整分析中，不同临床医生之间的IOH发生率差异很大。
术中低血压在社区麻醉实践中很常见，包括在通常被认为“低风险”的患者和环境中。经风险调整后，不同临床医生之间的发生率差异仍然存在，这表明IOH是质量改进计划中值得关注的可改变风险。
