Division of Anesthesia, Intensive Care, and Pain Management, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel.
Adelson School of Medicine, Ariel University, Ariel, Israel.
Anesthesiology. 2024 Oct 1;141(4):707-718. doi: 10.1097/ALN.0000000000005149.
Intraoperative hypotension might contribute to the development of postoperative delirium through inadequate cerebral perfusion. However, evidence regarding the association between intraoperative hypotension and postoperative delirium is equivocal. Therefore, the hypothesis that intraoperative hypotension is associated with postoperative delirium in patients older than 70 yr having elective noncardiac surgery was tested .
This was a retrospective cohort analysis of patients older than 70 yr who underwent elective noncardiac surgery in a single tertiary academic center between 2020 and 2021. Intraoperative hypotension was quantified as the area under a mean arterial pressure (MAP) threshold of 65 mmHg. Postoperative delirium was defined as a collapsed composite outcome including a positive 4 A's test during the initial 2 postoperative days, and/or delirium identification using the Chart-based Delirium Identification Instrument. The association between hypotension and postoperative delirium was assessed using multivariable logistic regression, adjusting for potential confounding variables. Several sensitivity analyses were performed using similar regression models.
In total, 2,352 patients were included (median age, 76 yr; 1,112 [47%] women; 1,166 [50%] American Society of Anesthesiologists Physical Status III or greater; 698 [31%] having high-risk surgeries). The median [interquartile range] intraoperative area under the curve below a threshold of MAP less than 65 mmHg was 28 [0, 103] mmHg · min. The overall incidence of postoperative delirium was 14% (327 of 2,352). After adjustment for potential confounding variables, hypotension was not associated with postoperative delirium. Compared to the first quartile of area under the curve below a threshold of MAP less than 65 mmHg, patients in the second, third, and fourth quartiles did not have more postoperative delirium, with adjusted odds ratios of 0.94 (95% CI, 0.64 to 1.36; P = 0.73), 0.95 (95% CI, 0.66 to 1.36; P = 0.78), and 0.95 (95% CI, 0.65 to 1.36; P = 0.78), respectively. Intraoperative hypotension was also not associated with postoperative delirium in any of the sensitivity and subgroup analyses performed.
To the extent of hypotension observed in our cohort, our results suggest that intraoperative hypotension is not associated with postoperative delirium in elderly patients having elective noncardiac surgery.
术中低血压可能通过脑灌注不足导致术后谵妄的发生。然而，术中低血压与术后谵妄之间的关联证据尚无定论。因此，本研究旨在检验择期非心脏手术的 70 岁以上老年患者术中低血压与术后谵妄相关的假说。
这是一项回顾性队列分析，纳入了 2020 年至 2021 年期间在一家单中心三级学术中心接受择期非心脏手术的 70 岁以上老年患者。术中低血压定义为平均动脉压（MAP）低于 65mmHg 的面积。术后谵妄采用初始 2 天内阳性 4A's 测试和/或使用 Chart-based Delirium Identification Instrument 进行谵妄识别的复合结局进行定义。采用多变量逻辑回归评估低血压与术后谵妄之间的关系，并对潜在混杂变量进行调整。使用相似的回归模型进行了几项敏感性分析。
共纳入 2352 例患者（中位年龄 76 岁；1112 例[47%]女性；1166 例[50%]美国麻醉医师协会身体状况分级Ⅲ或更高；698 例[31%]接受高风险手术）。术中 MAP 低于 65mmHg 的曲线下面积中位数[四分位间距]为 28[0，103]mmHg·min。术后谵妄的总发生率为 14%（327 例/2352 例）。调整潜在混杂变量后，低血压与术后谵妄无关。与 MAP 低于 65mmHg 的曲线下面积第一四分位数相比，第二、三、四分位数患者的术后谵妄发生率无差异，校正后比值比分别为 0.94（95%可信区间，0.64 至 1.36；P=0.73）、0.95（95%可信区间，0.66 至 1.36；P=0.78）和 0.95（95%可信区间，0.65 至 1.36；P=0.78）。在进行的任何敏感性分析和亚组分析中，术中低血压也与术后谵妄无关。
在本研究队列观察到的低血压程度范围内，结果表明择期非心脏手术的老年患者术中低血压与术后谵妄无关。
