Can routine perioperative haemodynamic parameters predict postoperative morbidity after major surgery?

Abstract Background Postoperative morbidity occurs in 10–15% of patients undergoing major noncardiac surgery. Predicting patients at higher risk of morbidity may help to optimize perioperative prevention. Preoperative haemodynamic parameters, systolic arterial pressure (SAP) < 100 mmHg, pulse pre...

Full description

Bibliographic Details
Main Authors: Jean-Francois Bonnet, Eleanor Buggy, Barbara Cusack, Aislinn Sherwin, Tom Wall, Maria Fitzgibbon, Donal J. Buggy
Format: Article
Language:English
Published: BMC 2020-03-01
Series:Perioperative Medicine
Subjects:
Online Access:http://link.springer.com/article/10.1186/s13741-020-0139-6
_version_ 1818012858623983616
author Jean-Francois Bonnet
Eleanor Buggy
Barbara Cusack
Aislinn Sherwin
Tom Wall
Maria Fitzgibbon
Donal J. Buggy
author_facet Jean-Francois Bonnet
Eleanor Buggy
Barbara Cusack
Aislinn Sherwin
Tom Wall
Maria Fitzgibbon
Donal J. Buggy
author_sort Jean-Francois Bonnet
collection DOAJ
description Abstract Background Postoperative morbidity occurs in 10–15% of patients undergoing major noncardiac surgery. Predicting patients at higher risk of morbidity may help to optimize perioperative prevention. Preoperative haemodynamic parameters, systolic arterial pressure (SAP) < 100 mmHg, pulse pressure (PP) > 62 mmHg or < 53 mmHg, and heart rate (HR) > 87 min-1 are associated with increased postoperative morbidity. We evaluated the correlation between these and other routine haemodynamic parameters, measured intraoperatively, with postoperative morbidity. Postoperative morbidity was measured using the Comprehensive Complication Index (CCI) and length of stay (LOS). Additionally we correlated CCI with the cardiac risk biomarker, preoperative NT-ProBNP. Methods This is a retrospective analysis of patients in MET-REPAIR, a European observational study correlating self-reported physical activity with postoperative morbidity. Patients’ electronic anaesthetic records (EARs) including perioperative haemodynamic data were correlated with 30-day postoperative morbidity, CCI and LOS parameters. Statistical analysis to assess for correlation was by Kendall’s Correlation Coefficient for tied ranks (Tau-B) or Spearman’s Correlation Coefficient. Blood for N-terminal prohormone of brain natriuretic peptide (NT-proBNP) measurement was collected < 31 days before surgery. Results Data from n = 50 patients were analysed. When stratified according to age > 70 years and ASA > 3, the duration of MAP < 100 mmHg, < 75 mmHg or < 55 mmHg were associated with a higher CCI (tau = 0.57, p = 0.001) and duration < 75 mmHg was associated with prolonged LOS (tau = 0.39, p = 0.02). The intraoperative duration of PP > 62 mmHg was associated with LOS (tau = 0.317, p = 0.007). There was no correlation between preoperative NT-proBNP and either CCI or LOS. Conclusions In older and higher risk patients, duration of intraoperative hypotension by a variety of definitions, or PP > 62 mmHg, are associated with increased postoperative CCI and LOS. These findings warrant confirmation in larger databases with evaluation of whether real-time intraoperative intervention could reduce postoperative morbidity.
first_indexed 2024-04-14T06:25:56Z
format Article
id doaj.art-2e1c54e3cc684aa9aa176d9f27910f12
institution Directory Open Access Journal
issn 2047-0525
language English
last_indexed 2024-04-14T06:25:56Z
publishDate 2020-03-01
publisher BMC
record_format Article
series Perioperative Medicine
spelling doaj.art-2e1c54e3cc684aa9aa176d9f27910f122022-12-22T02:07:50ZengBMCPerioperative Medicine2047-05252020-03-01911910.1186/s13741-020-0139-6Can routine perioperative haemodynamic parameters predict postoperative morbidity after major surgery?Jean-Francois Bonnet0Eleanor Buggy1Barbara Cusack2Aislinn Sherwin3Tom Wall4Maria Fitzgibbon5Donal J. Buggy6Department of Anaesthesiology & Perioperative Medicine, Mater University Hospital, School of Medicine, University College DublinDepartment of Anaesthesiology & Perioperative Medicine, Mater University Hospital, School of Medicine, University College DublinDepartment of Anaesthesiology & Perioperative Medicine, Mater University Hospital, School of Medicine, University College DublinDepartment of Anaesthesiology & Perioperative Medicine, Mater University Hospital, School of Medicine, University College DublinDepartment of Anaesthesiology & Perioperative Medicine, Mater University Hospital, School of Medicine, University College DublinDepartment of Medical Biochemistry, Mater University Hospital, School of Medicine, University College DublinDepartment of Anaesthesiology & Perioperative Medicine, Mater University Hospital, School of Medicine, University College DublinAbstract Background Postoperative morbidity occurs in 10–15% of patients undergoing major noncardiac surgery. Predicting patients at higher risk of morbidity may help to optimize perioperative prevention. Preoperative haemodynamic parameters, systolic arterial pressure (SAP) < 100 mmHg, pulse pressure (PP) > 62 mmHg or < 53 mmHg, and heart rate (HR) > 87 min-1 are associated with increased postoperative morbidity. We evaluated the correlation between these and other routine haemodynamic parameters, measured intraoperatively, with postoperative morbidity. Postoperative morbidity was measured using the Comprehensive Complication Index (CCI) and length of stay (LOS). Additionally we correlated CCI with the cardiac risk biomarker, preoperative NT-ProBNP. Methods This is a retrospective analysis of patients in MET-REPAIR, a European observational study correlating self-reported physical activity with postoperative morbidity. Patients’ electronic anaesthetic records (EARs) including perioperative haemodynamic data were correlated with 30-day postoperative morbidity, CCI and LOS parameters. Statistical analysis to assess for correlation was by Kendall’s Correlation Coefficient for tied ranks (Tau-B) or Spearman’s Correlation Coefficient. Blood for N-terminal prohormone of brain natriuretic peptide (NT-proBNP) measurement was collected < 31 days before surgery. Results Data from n = 50 patients were analysed. When stratified according to age > 70 years and ASA > 3, the duration of MAP < 100 mmHg, < 75 mmHg or < 55 mmHg were associated with a higher CCI (tau = 0.57, p = 0.001) and duration < 75 mmHg was associated with prolonged LOS (tau = 0.39, p = 0.02). The intraoperative duration of PP > 62 mmHg was associated with LOS (tau = 0.317, p = 0.007). There was no correlation between preoperative NT-proBNP and either CCI or LOS. Conclusions In older and higher risk patients, duration of intraoperative hypotension by a variety of definitions, or PP > 62 mmHg, are associated with increased postoperative CCI and LOS. These findings warrant confirmation in larger databases with evaluation of whether real-time intraoperative intervention could reduce postoperative morbidity.http://link.springer.com/article/10.1186/s13741-020-0139-6Haemodynamic parametersPredictorMorbidityIntraoperativeComplicationsNT-ProBNP
spellingShingle Jean-Francois Bonnet
Eleanor Buggy
Barbara Cusack
Aislinn Sherwin
Tom Wall
Maria Fitzgibbon
Donal J. Buggy
Can routine perioperative haemodynamic parameters predict postoperative morbidity after major surgery?
Perioperative Medicine
Haemodynamic parameters
Predictor
Morbidity
Intraoperative
Complications
NT-ProBNP
title Can routine perioperative haemodynamic parameters predict postoperative morbidity after major surgery?
title_full Can routine perioperative haemodynamic parameters predict postoperative morbidity after major surgery?
title_fullStr Can routine perioperative haemodynamic parameters predict postoperative morbidity after major surgery?
title_full_unstemmed Can routine perioperative haemodynamic parameters predict postoperative morbidity after major surgery?
title_short Can routine perioperative haemodynamic parameters predict postoperative morbidity after major surgery?
title_sort can routine perioperative haemodynamic parameters predict postoperative morbidity after major surgery
topic Haemodynamic parameters
Predictor
Morbidity
Intraoperative
Complications
NT-ProBNP
url http://link.springer.com/article/10.1186/s13741-020-0139-6
work_keys_str_mv AT jeanfrancoisbonnet canroutineperioperativehaemodynamicparameterspredictpostoperativemorbidityaftermajorsurgery
AT eleanorbuggy canroutineperioperativehaemodynamicparameterspredictpostoperativemorbidityaftermajorsurgery
AT barbaracusack canroutineperioperativehaemodynamicparameterspredictpostoperativemorbidityaftermajorsurgery
AT aislinnsherwin canroutineperioperativehaemodynamicparameterspredictpostoperativemorbidityaftermajorsurgery
AT tomwall canroutineperioperativehaemodynamicparameterspredictpostoperativemorbidityaftermajorsurgery
AT mariafitzgibbon canroutineperioperativehaemodynamicparameterspredictpostoperativemorbidityaftermajorsurgery
AT donaljbuggy canroutineperioperativehaemodynamicparameterspredictpostoperativemorbidityaftermajorsurgery