Canadian journal of anaesthesia = Journal canadien d'anesthesie · 2026
Assessment of risk factors for the development of postoperative hypotension in patients undergoing colorectal surgery: a historical cohort study.
СтатьяНазвание и аннотация: Перевод в очереди
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Ramos Ryan, Boutros Marylise, Kostenko Oleksandra, Weigartshofer Antonio, Yang Stephen S
Аннотация
PURPOSE: Postoperative hypotension, a common complication after colorectal surgery, is associated with an increased incidence of surgical site infections and prolonged hospitalization. Despite the prevalence of postoperative hypotension, limited research has examined the modifiable and nonmodifiable risk factors for developing postoperative hypotension in patients who have undergone colorectal surgery. We sought to determine the association of postoperative hypotension with a range of preoperative modifiable and nonmodifiable risk factors.
METHODS: This historical cohort study included all adult patients who underwent colorectal surgery for any indication between January 2013 and December 2017 in a single, university-affiliated tertiary care centre (Jewish General Hospital, Montreal, QC, Canada). We used multivariable logistic regression to analyze the association between preoperative variables and postoperative hypotension, defined as either systolic blood pressure < 90 mm Hg or the need for vasopressor infusion in the postanesthetic care unit or on postoperative days 0-3 on the surgical ward. We performed model validation using calibration and discrimination through bootstrapping techniques.
RESULTS: We included 982 patients. Postoperative hypotension occurred in 272 (28%) patients. Modifiable risk factors for postoperative hypotension included epidural analgesia (adjusted odds ratio [aOR], 2.32; 95% confidence interval [CI], 1.52 to 3.57; P < 0.001) and preoperative beta-blocker use (aOR, 1.71; 95% CI, 1.04 to 2.83; P = 0.04). Laparoscopic surgery (aOR, 0.48; 95% CI, 0.30 to 0.78; P = 0.003) and higher preoperative systolic blood pressure (aOR, 0.97; 95% CI, 0.96 to 0.98; P < 0.001) were protective factors for postoperative hypotension.
CONCLUSIONS: Epidural analgesia was associated with postoperative hypotension. The hemodynamic effects of epidural analgesia should be considered before insertion, especially in patients undergoing high-risk surgery, in whom postoperative hypotension may have substantial negative consequences.
METHODS: This historical cohort study included all adult patients who underwent colorectal surgery for any indication between January 2013 and December 2017 in a single, university-affiliated tertiary care centre (Jewish General Hospital, Montreal, QC, Canada). We used multivariable logistic regression to analyze the association between preoperative variables and postoperative hypotension, defined as either systolic blood pressure < 90 mm Hg or the need for vasopressor infusion in the postanesthetic care unit or on postoperative days 0-3 on the surgical ward. We performed model validation using calibration and discrimination through bootstrapping techniques.
RESULTS: We included 982 patients. Postoperative hypotension occurred in 272 (28%) patients. Modifiable risk factors for postoperative hypotension included epidural analgesia (adjusted odds ratio [aOR], 2.32; 95% confidence interval [CI], 1.52 to 3.57; P < 0.001) and preoperative beta-blocker use (aOR, 1.71; 95% CI, 1.04 to 2.83; P = 0.04). Laparoscopic surgery (aOR, 0.48; 95% CI, 0.30 to 0.78; P = 0.003) and higher preoperative systolic blood pressure (aOR, 0.97; 95% CI, 0.96 to 0.98; P < 0.001) were protective factors for postoperative hypotension.
CONCLUSIONS: Epidural analgesia was associated with postoperative hypotension. The hemodynamic effects of epidural analgesia should be considered before insertion, especially in patients undergoing high-risk surgery, in whom postoperative hypotension may have substantial negative consequences.