The relationship between intraoperative hypotension and delirium after noncardiac surgery: a retrospective multicenter cohort study

Association Between Intraoperative Arterial Hypotension and Postoperative Delirium After Noncardiac Surgery: A Retrospective Multicenter Cohort Study: Intraoperative Hypotension and Delirium After Noncardiac Surgery: A Retrospective Multicenter Cohort Study Not sure
.

We hypothesized that the range of clinically common intraoperative hypotension was associated with the incidence of postoperative delirium Methods.
Adult noncardiac surgery patients selected to receive general anesthesia at 2 academic medical centers between 2005 and 2017 were included in this retrospective cohort study
.

The primary exposure factor was intraoperative hypotension, defined as the duration of intraoperative mean arterial pressure (MAP) <55 mmHg, divided into short (<15 min; median [interquartile range], 2 [1–4] ] min) and prolonged (≥15 min; median [interquartile range], 21 [17–31] min)
.

The primary outcome was postoperative delirium within 30 days of surgery
.

In a secondary analysis, we assessed the association of a 30% decrease in MAP from baseline with postoperative delirium
.

Using multivariate logistic regression adjusting for factors related to patient and surgical progress, including demographics, comorbidities, and markers of surgical severity Results Among 316,717 surgical patients included, 2183 (0.
7%) occurred within 30 days of surgery Postoperative delirium; short-term and long-term hypotension occurred in 41.
7% and 2.
6% of patients, respectively
.

MAP <55 mmHg was associated with postoperative delirium (short-term: [ORadj], 1.
57; 95% [CI], 1.
11–1.
33; P<.
001 and long-term: [ORadj], 1.
57; 95% CI, 1.
27–1.
94; P<.
001 .
001)
.

Long-term MAP <55 mmHg was more associated with postoperative delirium ([ORadj], 1.
29; 95% CI, 1.
05–1.
58; P=.
016)
.

The association between intraoperative hypotension and postoperative delirium was related to duration (MAP < 55 mmHg per 10 minutes: 1.
06; 9.
5% CI 1.
02–1.
09; P = .
001), with the effect magnified in patients undergoing prolonged surgery (P Interaction Effect = .
046; MAP < 55 mmHg with surgery >3 hours vs no MAP < 55 mmHg: [ORadj], 1.
40; 95% CI, 1.
23–1.
61; P < .
001)
.

A >30% decrease in MAP from baseline was not associated with postoperative delirium when adjusted for cumulative persistence of MAP <55 mmHg (short-term MAP decrease >30%: [ORadj], 1.
13; 95% CI, 0.
91–1.
40; P = .
262 and long-term MAP reduction >30%: [ORadj] 1.
19; 95% CI, 0.
95–1.
49; P = .
141) Conclusions in patients undergoing noncardiac surgery, the incidence of postoperative delirium was associated with intraoperative hypotension (MAP < 55 mmHg) ) was associated with an increased duration of surgery, and this association was particularly pronounced in patients undergoing prolonged surgery
.

Figure&Table Flowchart Baseline Characteristics Note: Work RVU Labor Value Points Primary and Secondary Outcomes Analysis of the Relationship between Intraoperative Hypotension and Postoperative Delirium Modified Effect Analysis