Association between intraoperative hypotension and 30-day mortality, major adverse cardiac events, and acute kidney injury after non-cardiac surgery: A meta-analysis of cohort studies

作者：Cu, Wan-Jie; Hou, Bai-Ling; Kwong, Joey S. W.; Tian, Xin; Qian, Yue; Cui, Yin; Hao, Jing; Li, Ju-Chen; Ma, Zheng-Liang^*; Cu, Xiao-Ping

来源：International Journal of Cardiology, 2018, 258: 68-73.

DOI：10.1016/j.ijcard.2018.01.137

• Intraoperative hypotension
• Mortality
• Major adverse cardiac events
• Acute kidney injury
• Non-cardiac surgery

Background: The association between intraoperative hypotension (IOH) and postoperative outcomes is not fully understood. We performed a meta-analysis to determine whether IOH is associated with increased risk of 30-day mortality, major adverse cardiac events (MACEs) and acute kidney injury (AKI) after non-cardiac surgery.
Methods: We searched PubMed and Embase through May 2016 to identify cohort studies that investigated the association between IOH and risk of 30-day mortality, MACEs, or AKI in adult patients after non-cardiac surgery. Ascertainment of IOH and assessment of outcomes were defined by the individual study. Considering the level of clinical heterogeneity, adjusted odds ratios (ORs) with 95% confidence interval (CIs) were pooled using a random-effects model. This meta-analysis is registered on PROSPERO (CRD42016049405).
Results: We included 14 cohort studies that were heterogeneous in terms of definition of IOH. IOH alone was associated with increased risk of 30-day mortality (OR 1.29 [95% CI, 1.19-1.411), MACEs (OR 1.59 [95% CI, 1.23-2.051), especially myocardial injury (OR 1.67 [95% CI, 1.31-2.131), and AKI (OR 139 [95% CI, 1.09-1.771). Triple low (IOH coincident with low bispectral index and low minimum alveolar concentration) also predicts increased risk of 30-day mortality (OR 1.32 [95% CI, 1.03-1.68]).
Conclusions: IOH alone significantly increases the risk of postoperative 30-day mortality, MACEs, especially myocardial injury, and AKI in adult patients after non-cardiac surgery. Triple low also predicts increased risk of 30-day mortality after non-cardiac surgery. These findings provide evidence that IOH should be recognized as an independent risk factor for postoperative adverse outcomes after non-cardiac surgery.

• 出版日期2018-5-1
• 单位南京大学; 重庆医科大学