Journal of clinical anesthesia · 2025
The effect of postoperative hypotension on surgical patients' adverse clinical outcomes: A systematic review and meta-analysis.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод пока не подготовлен
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Han Shunyu, Zeng Tao, Xie Yumei, Liu Chang, Yang Lina, Yang Mengchang
Аннотация
INTRODUCTION: Postoperative hypotension (POH) represents an independent predictor of multiorgan morbidity. Emerging evidence indicates its risks exceed those associated with intraoperative hypotension (IOH). Considering the ubiquitous presence of this pathophysiological disturbance across surgical settings, our meta-analysis evaluates associations between POH and major adverse outcomes.
METHODS: We systematically searched PubMed, Web of Science, Cochrane Library, and Embase for clinical studies investigating POH and adverse outcomes, with literature coverage through 7 February 2025. Mortality during follow-up was designated as the primary outcome. Secondary outcomes included acute kidney injury (AKI), myocardial injury, delirium, stroke, and postoperative length of stay (LOS). Publication bias was assessed using Egger's test and trim-and-fill analysis; sensitivity analyses employed the leave-one-out method; and subgroup analysis was performed to explore heterogeneity.
RESULTS: This meta-analysis incorporated 23 studies involving 262,435 patients. Significant associations were identified between POH and adverse outcomes, including mortality (OR = 2.51, 95 % confidence interval [CI] 1.86-3.38), AKI (OR = 1.72, 95 % CI 1.25-2.36), myocardial injury (OR = 2.52, 95 % CI 1.71-3.69), and stroke (OR = 1.82, 95 % CI 1.09-3.05). However, publication bias detected by the trim-and-fill method compromised the robustness of AKI findings, while the stroke association demonstrated instability in leave-one-out sensitivity analyses. Subgroup analyses identified multiple POH thresholds as the primary source of heterogeneity.
CONCLUSION: These findings establish POH as a clinically significant correlate of postoperative mortality and myocardial injury. However, POH associations with AKI and stroke exhibit limited robustness, requiring further investigation. Future studies must delineate the impact of POH depth, duration, and measurement method.
METHODS: We systematically searched PubMed, Web of Science, Cochrane Library, and Embase for clinical studies investigating POH and adverse outcomes, with literature coverage through 7 February 2025. Mortality during follow-up was designated as the primary outcome. Secondary outcomes included acute kidney injury (AKI), myocardial injury, delirium, stroke, and postoperative length of stay (LOS). Publication bias was assessed using Egger's test and trim-and-fill analysis; sensitivity analyses employed the leave-one-out method; and subgroup analysis was performed to explore heterogeneity.
RESULTS: This meta-analysis incorporated 23 studies involving 262,435 patients. Significant associations were identified between POH and adverse outcomes, including mortality (OR = 2.51, 95 % confidence interval [CI] 1.86-3.38), AKI (OR = 1.72, 95 % CI 1.25-2.36), myocardial injury (OR = 2.52, 95 % CI 1.71-3.69), and stroke (OR = 1.82, 95 % CI 1.09-3.05). However, publication bias detected by the trim-and-fill method compromised the robustness of AKI findings, while the stroke association demonstrated instability in leave-one-out sensitivity analyses. Subgroup analyses identified multiple POH thresholds as the primary source of heterogeneity.
CONCLUSION: These findings establish POH as a clinically significant correlate of postoperative mortality and myocardial injury. However, POH associations with AKI and stroke exhibit limited robustness, requiring further investigation. Future studies must delineate the impact of POH depth, duration, and measurement method.