Journal of clinical anesthesia · 2025
Impacts of extreme temperature events on intraoperative hypotension: Evidence from a multicenter cohort study of 276,515 patients.
СтатьяМногоцентровое исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Huang Ruijian, Cheng Dan, Zhang Chen, Qian Cheng, Yin Xuan, Kong Siyu, Li Xinchi, Tan Qilian, Ge Yali, Liu Xuesheng, Shi Hongwei, Yang Fan, Ning Xiao, Zhang Zhimin, Chen Lihai, Sun Jie, Zhou Jifang
Аннотация
BACKGROUND: Extreme temperature events (ETEs) pose increasing risks for surgical patients, who may be vulnerable to temperature fluctuations. The associations between ETEs and intraoperative hypotension (IOH) remain understudied.
METHODS: We conducted a retrospective cohort analysis on patients undergoing major surgery between 2015 and 2023 at three large academic centers. ETEs were defined using percentile-based temperature thresholds and duration. Heat waves were periods of at least 3 consecutive days with daily average temperatures at or above the 95th or 97.5th percentiles of the previous 30 days, while cold spells were periods with temperatures at or below the 5th or 2.5th percentiles. The primary outcome was IOH ≥10 min, defined as a mean arterial pressure < 65 mmHg for ≥10 min. Secondary outcome was the duration of IOH ≥10 min. Logistic regression and generalized linear models were used to assess associations, adjusting for relevant covariates.
RESULTS: Among 276,515 eligible subjects, 48,023 were exposed to heat waves, 42,615 to cold spells, and 185,877 remained unexposed. The presence of an arterial catheter was noted in 30.31 % of the patients. Heat waves were associated with a reduced risk of IOH lasting ≥10 min (adjusted odds ratio [aOR], 0.80; 95 % confidence interval [CI], 0.76-0.84; P < 0.001). The total difference in IOH duration across the range of 30-day average temperatures from 0 to 30 °C was approximately 4 min, highlighting the modest magnitude of the effect. Cold spells were associated with an increased IOH risk, with the strongest association observed for cold spells defined by the 2.5th percentile lasting 4 days (aOR, 1.31; 95 % CI, 1.24-1.39; P < 0.001). The magnitude of risk also increased with longer IOH duration. Restricted cubic spline analyses further revealed non-linear associations with the duration of IOH for mean temperature 30 days prior to admission (p-nonlinearity = 0.036).
CONCLUSION: ETEs were associated with IOH, with heat waves reducing risk and cold spells increasing risk. These results provide new evidence on the physiological effects of environmental temperature extremes in the perioperative setting.
METHODS: We conducted a retrospective cohort analysis on patients undergoing major surgery between 2015 and 2023 at three large academic centers. ETEs were defined using percentile-based temperature thresholds and duration. Heat waves were periods of at least 3 consecutive days with daily average temperatures at or above the 95th or 97.5th percentiles of the previous 30 days, while cold spells were periods with temperatures at or below the 5th or 2.5th percentiles. The primary outcome was IOH ≥10 min, defined as a mean arterial pressure < 65 mmHg for ≥10 min. Secondary outcome was the duration of IOH ≥10 min. Logistic regression and generalized linear models were used to assess associations, adjusting for relevant covariates.
RESULTS: Among 276,515 eligible subjects, 48,023 were exposed to heat waves, 42,615 to cold spells, and 185,877 remained unexposed. The presence of an arterial catheter was noted in 30.31 % of the patients. Heat waves were associated with a reduced risk of IOH lasting ≥10 min (adjusted odds ratio [aOR], 0.80; 95 % confidence interval [CI], 0.76-0.84; P < 0.001). The total difference in IOH duration across the range of 30-day average temperatures from 0 to 30 °C was approximately 4 min, highlighting the modest magnitude of the effect. Cold spells were associated with an increased IOH risk, with the strongest association observed for cold spells defined by the 2.5th percentile lasting 4 days (aOR, 1.31; 95 % CI, 1.24-1.39; P < 0.001). The magnitude of risk also increased with longer IOH duration. Restricted cubic spline analyses further revealed non-linear associations with the duration of IOH for mean temperature 30 days prior to admission (p-nonlinearity = 0.036).
CONCLUSION: ETEs were associated with IOH, with heat waves reducing risk and cold spells increasing risk. These results provide new evidence on the physiological effects of environmental temperature extremes in the perioperative setting.