Predicting early postoperative hypotension after lung resection: a multiparameter model integrating non-invasive hemodynamic profiling and inferior vena cava collapsibility index (observational study).

OBJECTIVE

To analyze the influencing factors of postoperative hypotension (POH) following video-assisted thoracoscopic lung resection (VATS) and evaluate a predictive model combining non-invasive hemodynamic parameters with the inferior vena cava collapsibility index (IVCCI).

METHODS

A prospective study enrolled 100 VATS patients (September 2024-March 2025). Patients were stratified into POH (n = 36) and Non-POH (n = 64) groups based on mean arterial pressure (MAP ≤ 65 mmHg or ≥ 30% reduction from baseline) within 24 hours postoperatively. Hemodynamic parameters (cardiac output [CO], systemic vascular resistance [SVR], stroke volume [SV], stroke volume variation [SVV], left ventricular stroke work [LVSW]) were monitored using the Non-invasive Continuous Arterial Blood Pressure And Cardiac Output Monitoring System. IVCCI was ultrasonographically measured post-extubation. Linear regression analyzed correlations between post-anesthetic emergence period hemodynamic parameters and POH, while multivariable logistic regression analysis was employed to identify predictive factors, leading to the development and validation of a clinical prediction model.

RESULTS

The incidence of early POH was 36%. Multivariate analysis demonstrated that a model combining post-anesthesia emergence period left ventricular stroke work (PA_LVSW, OR = 0.880, P < 0.01), IVCCI (OR = 1.095, P = 0.01), baseline MAP, and ASA achieved an AUC of 0.940 (95% CI: 0.895-0.985), with 83.3% sensitivity and 89.1% specificity, outperforming individual predictors (IVCCI: AUC = 0.65; PA_LVSW༚AUC = 0.84).

CONCLUSION

Early POH after VATS is closely associated with cardiac function suppression and volume status imbalance. The multiparameter model integrating PA_LVSW, IVCCI, ASA physical status, and baseline MAP effectively predicts POH.

TRIAL REGISTRATION: Chinese Clinical Trial Register, ChiCTR2500100275. Registered 7 April 2025 Retrospectively registered, https//www.chictr.org.cn/showprojEN.html? proj=259,898.