Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan.
Department of Materials Process Engineering, Nagoya University, Nagoya, Japan.
Can J Anaesth. 2024 Mar;71(3):343-352. doi: 10.1007/s12630-023-02653-6. Epub 2023 Nov 21.
We aimed to elucidate whether postinduction hypotension (PIH), defined as hypotension between anesthesia induction and skin incision, and intraoperative hypotension (IOH) are associated with postoperative mortality.
We conducted a retrospective cohort study of adult patients with an ASA Physical Status I-IV who underwent noncardiac and nonobstetric surgery under general anesthesia between 2015 and 2021 at Nagoya City University Hospital. The primary and secondary outcomes were 30-day and 90-day postoperative mortality, respectively. We calculated four hypotensive indices (with time proportion of the area under the threshold being the primary exposure variable) to evaluate the association between hypotension (defined as a mean blood pressure < 65 mm Hg) and mortality using multivariable logistic regression models. We used propensity score matching and RUSBoost (random under-sampling and boosting), a machine-learning model for imbalanced data, for sensitivity analyses.
Postinduction hypotension and IOH were observed in 82% and 84% of patients, respectively. The 30-day and 90-day postoperative mortality rates were 0.4% (52/14,210) and 1.0% (138/13,334), respectively. Postinduction hypotension was not associated with 30-day mortality (adjusted odds ratio [aOR], 1.03; 95% confidence interval [CI], 0.93 to 1.13; P = 0.60) and 90-day mortality (aOR, 1.01; 95% CI, 0.94 to 1.07; P = 0.82). Conversely, IOH was associated with 30-day mortality (aOR, 1.19; 95% CI, 1.12 to 1.27; P < 0.001) and 90-day mortality (aOR, 1.12; 95% CI, 1.06 to 1.19; P < 0.001). Sensitivity analyses supported the association of IOH but not PIH with postoperative mortality.
Despite limitations, including power and residual confounding, postoperative mortality was associated with IOH but not with PIH.
我们旨在阐明麻醉诱导至皮肤切开期间的低血压（定义为低血压）和术中低血压（IOH）是否与术后死亡率相关。
我们对 2015 年至 2021 年期间在名古屋城市大学医院接受全身麻醉下非心脏和非产科手术的 ASA 身体状况 I-IV 级成年患者进行了回顾性队列研究。主要和次要结局分别为术后 30 天和 90 天的死亡率。我们计算了四个低血压指数（时间比例作为主要暴露变量），使用多变量逻辑回归模型评估低血压（定义为平均血压<65mmHg）与死亡率之间的关系。我们使用倾向评分匹配和 RUSBoost（随机欠采样和提升）进行了敏感性分析，这是一种用于不平衡数据的机器学习模型。
分别有 82%和 84%的患者发生了诱导后低血压和 IOH。术后 30 天和 90 天的死亡率分别为 0.4%（52/14210）和 1.0%（138/13334）。诱导后低血压与 30 天死亡率（调整后的优势比[aOR]，1.03；95%置信区间[CI]，0.93 至 1.13；P=0.60）和 90 天死亡率（aOR，1.01；95%CI，0.94 至 1.07；P=0.82）无关。相反，IOH 与 30 天死亡率（aOR，1.19；95%CI，1.12 至 1.27；P<0.001）和 90 天死亡率（aOR，1.12；95%CI，1.06 至 1.19；P<0.001）相关。敏感性分析支持 IOH 与术后死亡率相关，但不支持 PIH 与术后死亡率相关。
尽管存在局限性，包括效力和残留混杂因素，但术后死亡率与 IOH 相关，与 PIH 无关。
