Preoperative and Intraoperative Blood Pressure Variability Independently Correlate with Outcomes

Relationship between intraoperative blood pressure variability and postoperative acute kidney injury in pediatric cardiac surgery

BACKGROUND

Cardiac surgery-associated acute kidney injury (CSA-AKI) is a notably common complication in pediatrics, with an incidence rate ranging from 15 to 64%. This rate is significantly higher than that observed in adults. Currently, there is a lack of substantial evidence regarding the association between intraoperative blood pressure variability (BPV) during cardiac surgery with cardiopulmonary bypass (CPB) and the development of AKI in pediatric patients.

METHODS

This retrospective observational study encompassed children aged 0-7 years undergoing cardiac surgery with CPB. Intraoperative BPV was calculated using coefficients of variation (CVs) and the area under the curve (AUC). Univariate and multivariate analyses were employed to identify risk factors associated with CSA-AKI.

RESULTS

Among 570 patients (median age 1 year) reviewed, 36.1% developed CSA-AKI (68.9% risk stage, 22.8% injury stage, and 8.3% failure stage). After adjusting for other variables, male gender (OR = 2.044, 95% CI 1.297-3.222, P = 0.002), congenital heart surgery risk assessment grade (RACHS-1) classification ≥ 3 (OR = 0.510, 95% CI 0.307-0.846, P = 0.009), longer CPB time (OR = 1.022, 95% CI 1.007-1.037, P = 0.004) and higher peak value of intraoperative vasoactive inotropic score (VIS) (OR = 1.072, 95% CI 1.026-1.119, P = 0.002) were identified as independent risk factors for CSA-AKI. ± 30% AUCm was different in univariate analysis (P = 0.014), however, not statistically different in multifactor analysis (P = 0.610).

CONCLUSION

Greater BPV, specifically MAP variations exceeding 30% AUC during CPB, may be a potential risk factor for CSA-AKI in pediatric patients. Further large sample clinical studies are warranted to analyze the correlation between BPV and CSA-AKI.

Perioperative systemic blood pressure parameters and clinical outcomes following 27g vitrectomy for diabetic tractional detachment repair

Background

Extremes in perioperative blood pressures are known risk factors for adverse outcomes after surgical interventions. There is scarce literature studying these parameters as predictors of outcomes after ocular surgery.

Methods

This was a retrospective single-centre interventional cohort analysis to evaluate the relationship between perioperative (preoperative and intraoperative) blood pressure value and variability and postoperative visual and anatomic outcomes. Included were patients who underwent primary 27-gauge (27g) vitrectomy for repair of diabetic tractional retinal detachment (DM-TRD) with at least 6 months of follow-up. Univariate analyses were conducted via independent two-sided t-tests and Pearson’s χ2tests. Multivariate analyses were conducted via generalised estimating equations.

Results

71 eyes of 57 patients were included in the study. Higher preprocedure mean arterial pressure (MAP) was associated with fewer Snellen lines of improvement at postoperative month 6 (POM6) (p<0.01). Higher mean intraoperative systolic blood pressure (SBP), diastolic blood pressure and MAP were associated with visual acuity 20/200 or worse at POM6 (p<0.05). Patients with sustained intraoperative hypertension had 1.77 times the risk of visual acuity 20/200 or worse at POM6 compared with those without sustained intraoperative hypertension (p=0.006). Higher SBP variability was associated with worse visual outcomes at POM6 (p<0.05). Blood pressure was not associated with macular detachment at POM6 (p>0.10).

Conclusions

Higher average perioperative blood pressure and blood pressure variability are associated with worse visual outcomes in patients undergoing 27g vitrectomy for DM-TRD repair. Patients with sustained intraoperative hypertension were approximately twice as likely to have visual acuity 20/200 or worse at POM6 compared to those without sustained intraoperative hypertension.