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Review
. 2023 May 1;9(5):e15997.
doi: 10.1016/j.heliyon.2023.e15997. eCollection 2023 May.

Association of intraoperative hypotension and severe postoperative complications during non-cardiac surgery in adult patients: A systematic review and meta-analysis

Jianghui Cai  1 , Mi Tang  2   3 , Huaye Wu  2 , Jing Yuan  4 , Hua Liang  1 , Xuan Wu  5 , Shasha Xing  3 , Xiao Yang  6 , Xiao-Dong Duan  7
Affiliations
Review

Association of intraoperative hypotension and severe postoperative complications during non-cardiac surgery in adult patients: A systematic review and meta-analysis

Jianghui Cai et al. Heliyon. .

Abstract

Background: Intraoperative hypotension (IOH) is a common side effect of non-cardiac surgery that might induce poor postoperative outcomes. The relationship between the IOH and severe postoperative complications is still unclear. Thus, we summarized the existing literature to evaluate whether IOH contributes to developing severe postoperative complications during non-cardiac surgery.

Methods: We conducted a comprehensive search of PubMed, Embase, Cochrane Library, Web of Science, and the CBM from inception to 15 September 2022. The primary outcomes were 30-day mortality, acute kidney injury (AKI), major adverse cardiac events (myocardial injury or myocardial infarction), postoperative cognitive dysfunction (POCD), and postoperative delirium (POD). Secondary outcomes included surgical-site infection (SSI), stroke, and 1-year mortality.

Results: 72 studies (3 randomized; 69 non-randomized) were included in this study. Low-quality evidence showed IOH resulted in an increased risk of 30-day mortality (OR, 1.85; 95% CI, 1.30-2.64; P < .001), AKI (OR, 2.69; 95% CI, 2.15-3.37; P < .001), and stroke (OR, 1.33; 95% CI, 1.21-1.46; P < .001) after non-cardiac surgery than non-IOH. Very low-quality evidence showed IOH was associated with a higher risk of myocardial injury (OR, 2.00; 95% CI, 1.17-3.43; P = .01), myocardial infarction (OR, 2.11; 95% CI, 1.41-3.16; P < .001), and POD (OR, 2.27; 95% CI, 1.53-3.38; P < .001). Very low-quality evidence showed IOH have a similar incidence of POCD (OR, 2.82; 95% CI, 0.83-9.50; P = .10) and 1-year-mortality (OR, 1.66; 95% CI, 0.65-4.20; P = .29) compared with non-IOH in non-cardiac surgery.

Conclusion: Our results suggest IOH was associated with an increased risk of severe postoperative complications after non-cardiac surgery than non-IOH. IOH is a potentially avoidable hazard that should be closely monitored during non-cardiac surgery.

Keywords: IOH; Intraoperative hypotension; Non-cardiac surgery; Severe postoperative complications.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
PRISMA Flow Diagram.
Fig. 2
Fig. 2
Forest Plot of odds ratio (OR) for 30-day mortality for IOH VS Non-IOH during non-cardiac surgery.
Fig. 3
Fig. 3
Forest Plot of AKI for IOH VS Non-IOH during non-cardiac surgery.
Fig. 4
Fig. 4
Forest Plot of myocardial injury for IOH VS Non-IOH during non-cardiac surgery.
Fig. 5
Fig. 5
Forest Plot of myocardial infarction for IOH VS Non-IOH during non-cardiac surgery.
See this image and copyright information in PMC

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