Intraoperative hypotension is associated with decreased long-term survival in older patients after major noncardiac surgery: Secondary analysis of three randomized trials
Abstract
STUDY OBJECTIVE
To assess the association of intraoperative hypotension with long-term survivals in older patients after major noncardiac surgery mainly for cancer.
DESIGN
A secondary analysis of databases from three randomized trials with long-term follow-up.
SETTING
The underlying trials were conducted in 17 tertiary hospitals in China.
PATIENTS
Patients aged 60 to 90 years who underwent major noncardiac thoracic or abdominal surgeries (≥ 2 h) in a single center were included in this analysis.
EXPOSURES
Restricted cubic spline models were employed to determine the lowest mean arterial pressure (MAP) threshold that was potentially harmful for long-term survivals. Patients were arbitrarily divided into three groups according to the cumulative duration or area under the MAP threshold. The association between intraoperative hypotension exposure and long-term survivals were analyzed with the Cox proportional hazard regression models.
MEASUREMENTS
Our primary endpoint was overall survival. Secondary endpoints included recurrence-free and event-free survivals.
MAIN RESULTS
A total of 2664 patients (mean age 69.0 years, 34.9% female sex, 92.5% cancer surgery) were included in the final analysis. MAP 10 min) or area under MAP 30 mmHg⋅min). After adjusting confounders, duration under MAP 10 min was associated with a shortened overall survival when compared with the 30 mmHg⋅min was associated with a shortened overall survival when compared with the 10 min or area under MAP 30…
How strong is the evidence?
Evidence Hub reads this as a secondary / pooled analysis, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 2,664 participants or records.
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