International journal of surgery (London, England) · 2025
Impact of mildly elevated pulmonary artery systolic pressure on hypotension and myocardial injury during thoracoscopic lobectomy: a retrospective cohort study.
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Fu Yu, Yu Jing, Jiang Xuemei, Gao Jiameng, Zhang Zhiyuan, Zhang Nan, Jin Yang, Chen Chang, Wen Zongmei
Аннотация
BACKGROUND: The impact of mildly elevated pulmonary artery systolic pressure (PASP) on perioperative hemodynamic stability and myocardial injury during thoracoscopic lobectomy remains inadequately characterized despite its prevalence in the surgical population.
METHODS: This retrospective cohort study analyzed 3579 patients who underwent thoracoscopic lobectomy. Patients were categorized as having normal or mildly elevated PASP. Propensity score matching (PSM) was used to balance baseline characteristics between groups. The primary outcome was intraoperative hypotension. Secondary outcomes included myocardial injury after noncardiac surgery (MINS), hypoxemia, new-onset atrial fibrillation, postoperative pulmonary complications, 30-day readmission, and 30-day mortality. Sensitivity analyses using inverse probability of treatment weighting (IPTW) and overlap weighting were performed to validate the robustness of findings.
RESULTS: Among 3579 patients, 16.6% ( n = 594) had mildly elevated PASP. After PSM (491 pairs), patients with mildly elevated PASP experienced significantly higher rates of intraoperative hypotension [46.4 vs. 35.2%; odds ratio (OR) = 1.525; 95% CI: 1.190-1.957; P < 0.001]. Both short-duration (<15 min) and prolonged (≥15 min) hypotensive episodes occurred more frequently in the mildly elevated PASP group (30.1 vs. 22% and 16.3 vs. 13.2%, respectively). Mildly elevated PASP was also associated with higher postoperative NT-proBNP and hsTnT levels, and increased incidence of MINS (20.4 vs. 12.4%; OR = 1.803; 95% CI: 1.279-2.56; P < 0.001). These associations remained consistent across IPTW and overlap weighting analyses. Independent predictors of elevated PASP included smoking history (OR = 2.817), COPD (OR = 2.199), higher BMI (OR = 1.168 per unit), and older age (OR = 1.095 per year).
CONCLUSIONS: Mildly elevated PASP significantly increases the risk of intraoperative hypotension and myocardial injury during thoracoscopic lobectomy. These findings identify patients with mildly elevated PASP as a high-risk population requiring careful hemodynamic monitoring and management. Preoperative assessment of PASP may enhance risk stratification for patients undergoing thoracoscopic lobectomy.
METHODS: This retrospective cohort study analyzed 3579 patients who underwent thoracoscopic lobectomy. Patients were categorized as having normal or mildly elevated PASP. Propensity score matching (PSM) was used to balance baseline characteristics between groups. The primary outcome was intraoperative hypotension. Secondary outcomes included myocardial injury after noncardiac surgery (MINS), hypoxemia, new-onset atrial fibrillation, postoperative pulmonary complications, 30-day readmission, and 30-day mortality. Sensitivity analyses using inverse probability of treatment weighting (IPTW) and overlap weighting were performed to validate the robustness of findings.
RESULTS: Among 3579 patients, 16.6% ( n = 594) had mildly elevated PASP. After PSM (491 pairs), patients with mildly elevated PASP experienced significantly higher rates of intraoperative hypotension [46.4 vs. 35.2%; odds ratio (OR) = 1.525; 95% CI: 1.190-1.957; P < 0.001]. Both short-duration (<15 min) and prolonged (≥15 min) hypotensive episodes occurred more frequently in the mildly elevated PASP group (30.1 vs. 22% and 16.3 vs. 13.2%, respectively). Mildly elevated PASP was also associated with higher postoperative NT-proBNP and hsTnT levels, and increased incidence of MINS (20.4 vs. 12.4%; OR = 1.803; 95% CI: 1.279-2.56; P < 0.001). These associations remained consistent across IPTW and overlap weighting analyses. Independent predictors of elevated PASP included smoking history (OR = 2.817), COPD (OR = 2.199), higher BMI (OR = 1.168 per unit), and older age (OR = 1.095 per year).
CONCLUSIONS: Mildly elevated PASP significantly increases the risk of intraoperative hypotension and myocardial injury during thoracoscopic lobectomy. These findings identify patients with mildly elevated PASP as a high-risk population requiring careful hemodynamic monitoring and management. Preoperative assessment of PASP may enhance risk stratification for patients undergoing thoracoscopic lobectomy.