Common clinical thresholds of intraoperative hypotension and 30-day mortality following surgery: a retrospective cohort study

Philippe Dony, Laurence Seidel, Magali Pirson, Guy Haller
Acta Anaesthesiologica Scandinavica 2020 July 13

BACKGROUND: A wide range of thresholds define intraoperative hypotension and can be used to guide intraoperative blood pressure management. Many clinicians use the systolic blood pressure (SBP)<80 mmHg, the mean arterial pressure (MAP)<60 mmHg and the SBP percent drop from baseline (ΔSBP)>20% as alarming limits that should not be exceeded. Whether these common thresholds are valid limits that can inform clinicians on a possible increased risk of postoperative complications, particularly 30-day mortality, is currently unclear.

METHODS: We performed a retrospective registry-based cohort study between January 2015 and July 2016 using departmental hospital databases and the National Death Registry. Uni- and multivariate analyses were performed to assess the association between each of these three thresholds and 30-day postoperative mortality. Six specific markers of hypotension were used.

RESULTS: Of 11,304 patients, 86 (0.76%) died within 30 days following surgery. All intraoperative hypotension markers for SBP<80 mmHg and MAP<60 mmHg were significantly associated with 30-day mortality (P<0.005). Markers of ΔSBP>20% were not significant. After adjustment for age, gender, American Society of Anesthesiologists (ASA) score, emergency status and risk related to the type of surgery, both SBP<80 mmHg and MAP<60 mmHg (the percent area under the threshold marker) showed the strongest associations with 30-day mortality, with odds ratios (ORs) of 3.02 (95% confidence interval (CI) 1.81-5.07) and 3.77 (95%CI 2.25-6.31), respectively.

CONCLUSIONS: Commonly accepted thresholds of intraoperative hypotension, such as an SBP of 80 mmHg and an MAP of 60 mmHg, are valid alarming limits that are significantly and independently associated with 30-day mortality.

Full Text Links

We have located open access full text paper links.


You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read

Save your favorite articles in one place with a free QxMD account.


Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"