J Korean Med Sci.  2024 Sep;39(35):e241. 10.3346/jkms.2024.39.e241.

Impact of Preanesthetic Blood Pressure Deviations on 30-Day Postoperative Mortality in Non-Cardiac Surgery Patients

• Lee SW
• Park S
• Kim JY
• Moon B
• Lee D
• Jang J
• Seo Wy
• Kim HS
• Kim SH
• Sim J

• KMID: 2559194
• DOI: http://doi.org/10.3346/jkms.2024.39.e241

Abstract

Background
Blood pressure readings taken before anesthesia often influence the decision to delay or cancel elective surgeries. However, the implications of these specific blood pressure values, especially how they compare to baseline, on postoperative in-hospital 30-day mortality remain underexplored. This research aimed to examine the effect of discrepancies between the baseline blood pressure evaluated in the ward a day before surgery, and the blood pressure observed just before the administration of anesthesia, on the postoperative mortality risks.
Methods
The study encompassed 60,534 adults scheduled for non-cardiac surgeries at a tertiary care center in Seoul, Korea. Baseline blood pressure was calculated as the mean of the blood pressure readings taken within 24 hours prior to surgery. The preanesthetic blood pressure was the blood pressure measured right before the administration of anesthesia. We focused on in-hospital 30-day mortality as the primary outcome.
Results
Our research revealed that a lower preanesthetic systolic or mean blood pressure that deviates by 20 mmHg or more from baseline significantly increased the risk of 30-day mortality. This association was particularly pronounced in individuals with a history of hypertension and those aged 65 and above. Higher preanesthetic blood pressure was not significantly associated with an increased risk of 30-day mortality.
Conclusion
We found that a lower preanesthetic blood pressure compared to baseline significantly increased the 30-day postoperative mortality risk, whereas a higher preanesthetic blood pressure did not. Our study emphasizes the critical importance of accounting for variations in both baseline and preanesthetic blood pressure when assessing surgical risks and outcomes.

Keyword

Hospital Mortality; Postoperative Complications; Hypertension; Blood Pressure; Hypotension; Hemodynamic Monitoring

Figure

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  Fig. 1 Flow chart of study population including inclusion and exclusion criteria.ASA = American Society of Anesthesiologists.

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  Fig. 2 Unadjusted and fully adjusted spline graphs illustrate the association between preanesthetic-SBP, Diff-SBP, and perioperative mortality. The fully adjusted model accounts for age, sex, BMI, department of operation, and ASA class. Patients with and without a history of hypertension are analyzed separately in subsequent figures. (A) The unadjusted model shows a higher risk estimation for both low preanesthetic and Diff-SBP compared to adjusted model. (B) The adjusted model shows a relatively low risk estimation for both. Preanesthetic SBP lower than 80 mmHg or Diff-SBP lower than −20 mmHg are significantly associated with 30-day mortality risk.SBP = systolic blood pressure, Diff-SBP = differential systolic blood pressure, BMI = body mass index, ASA = American Society of Anesthesiologists, CI = confidence interval, DEP = department of operation.

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  Fig. 3 Unadjusted and fully adjusted spline graphs illustrate the association between Preanesthetic-MBP, Diff-MBP, and perioperative mortality. The fully adjusted model accounts for age, sex, BMI, department of operation, and ASA class. Patients with and without a history of hypertension are analyzed separately in subsequent figures. (A) The unadjusted model shows a higher risk estimation for both low preanesthetic and Diff-MBP compared to adjusted model. (B) The adjusted model shows a relatively low risk estimation for both. Preanesthetic MBP lower than 80 mmHg or Diff-MBP lower than −20 mmHg are significantly associated with 30-day mortality risk. Higher MBP do not reached statistical significance, except Diff-MBP equal to 40 mmHg.MBP = mean blood pressure, Diff-SBP = differential mean blood pressure, BMI = body mass index, ASA = American Society of Anesthesiologists, CI = confidence interval, DEP = department of operation.

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  Fig. 4 Fully adjusted spline graphs illustrating the association between Diff-BP, and perioperative mortality in different age groups (> 65 years) and history of hypertension. (A) > 65 with HTN. (B) ≤ 65 with HTN. (C) > 65 without HTN. (D) ≤ 65 without HTN.Diff-BP = differential blood pressure, HTN = hypertension, CI = confidence interval, SBP = systolic blood pressure, MBP = mean blood pressure, DBP = diastolic blood pressure.

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  Fig. 5 Fully adjusted spline graphs illustrating the association between Diff-MBP, and perioperative mortality in different age groups. (A) Age > 65, (B) age > 55, (C) age > 45, and (D) age > 35.Diff-MBP = differential mean blood pressure, HTN = hypertension, CI = confidence interval.

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