Daum Nils, Hoff Laerson, Spies Claudia, Pohrt Anne, Bald Annika, Langer Nadine, Kiselev Jörn, Drewniok Nils, Markus Maximilian, Hunsicker Oliver, Mörgeli Rudolf, Weiss Björn, von Wedel Dario, Balzer Felix, Schaller Stefan J
Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Anaesthesiology and Intensive Care Medicine (CCM/CVK), Berlin, Germany. Electronic address: https://twitter.com/@DaumNils.
Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Anaesthesiology and Intensive Care Medicine (CCM/CVK), Berlin, Germany.
Br J Anaesth. 2025 Jul;135(1):40-47. doi: 10.1016/j.bja.2024.10.050. Epub 2025 Jan 24.
Frailty is a predictor of morbidity and mortality in older patients. This study aimed to investigate the influence of frailty status on likelihood, rate, duration, and severity of intraoperative hypotension (IOH), which can lead to severe organ dysfunction.
Surgical patients (≥70 yr old) with preoperative frailty assessment were analysed retrospectively. Frailty status was defined as robust, prefrail, or frail based on modified Fried criteria. IOH was defined as mean arterial pressure <65 mm Hg. For likelihood, rate, duration, and severity of IOH, logistic and Poisson regression were used.
We included 2495 patients. There was no significant difference in likelihood of IOH. An increase of 9% in rate of IOH during surgery for prefrail (incidence rate ratio [IRR] 1.09 [95% CI 1.03-1.16], P=0.002), and 16% increase for frail patients (IRR 1.16 [1.04-1.29], P=0.007) was observed. During anaesthesia induction, prefrail patients exhibited a 28% increase in IOH (IRR 1.28 [1.12-1.47], P<0.001). Although there were no differences in the severity of IOH if surgery or anaesthesia induction duration was taken into account, frailty status was associated with a 15% longer time-weighted duration of IOH during anaesthesia induction (IRR 1.15 [1.06-1.24], P=0.001). Mediator analysis revealed that frailty status accounted for >90% after considering number of measured blood pressures and surgical duration and >70% after accounting for total propofol dose.
Prefrail and frail patients aged ≥70 yr experienced up to 16% more IOH during surgery and 28% more during anaesthesia induction compared with robust patients. Preoperative optimisation (prehabilitation) and modification of intraoperative management (e.g. invasive blood pressure management) have the potential to reduce IOH in prefrail and frail patients.
衰弱是老年患者发病和死亡的预测因素。本研究旨在调查衰弱状态对术中低血压（IOH）的可能性、发生率、持续时间和严重程度的影响，术中低血压可导致严重器官功能障碍。
对术前进行衰弱评估的手术患者（≥70岁）进行回顾性分析。根据改良的Fried标准，衰弱状态分为强健、衰弱前期或衰弱。IOH定义为平均动脉压<65mmHg。对于IOH的可能性、发生率、持续时间和严重程度，采用逻辑回归和泊松回归分析。
我们纳入了2495例患者。IOH的可能性无显著差异。衰弱前期患者手术期间IOH发生率增加9%（发病率比[IRR]1.09[95%CI 1.03-1.16]，P=0.002），衰弱患者增加16%（IRR 1.16[1.04-1.29]，P=0.007）。在麻醉诱导期间，衰弱前期患者的IOH增加28%（IRR 1.28[1.12-1.47]，P<0.001）。尽管考虑手术或麻醉诱导时间后IOH的严重程度没有差异，但衰弱状态与麻醉诱导期间IOH的时间加权持续时间延长15%相关（IRR 1.15[1.06-1.24]，P=0.001）。中介分析显示，在考虑测量血压次数和手术时间后，衰弱状态占比>90%，在考虑丙泊酚总剂量后占比>70%。
与强健患者相比，≥70岁的衰弱前期和衰弱患者在手术期间的IOH多16%，在麻醉诱导期间多28%。术前优化（预康复）和术中管理调整（如有创血压管理）有可能降低衰弱前期和衰弱患者的IOH。
