The impact of hypotension prediction index on intraoperative hypotension in elderly patients during pancreaticoduodenectomy: A randomized controlled trial.

BACKGROUND

Intraoperative hypotension, defined as a mean arterial pressure (MAP) of less than 65 mmHg, is a major concern in pancreaticoduodenectomy, particularly in elderly patients, due to its association with adverse postoperative outcomes. Hypotension Prediction Index (HPI) could predict intraoperative hypotension. We tested the hypothesis that HPI reduces intraoperative hypotension in these patients.

METHODS

This randomized trial enrolled 60 patients aged ≥65 years undergoing elective pancreaticoduodenectomy. Patients were randomly assigned to receive either HPI-guided hemodynamic management (intervention) or no HPI guidance (control) in a 1:1 ratio. Intraoperative hypotension treatment was initiated when HPI exceeded 85 (intervention) or MAP fell below 65 mmHg (control). The primary outcome was the time-weighted average (TWA) MAP <65 mmHg. Secondary outcomes included duration of hypotension, intraoperative and postoperative metrics, fluid and blood product use, vasoactive dose, and 30-day postoperative complications and mortality.

RESULTS

The intervention group had a significantly lower TWA MAP <65 mmHg value than the control group (0.02 mmHg [IQR, 0-0.11 mmHg] vs. 0.23 mmHg [0.12-0.73 mmHg], p < 0.001). There were no significant between-group differences in the use of fluids and blood products or in the dose of vasoactive drugs. However, the intervention group had fewer postoperative pulmonary and gastrointestinal complications than the control group. There was one death in each group.

CONCLUSIONS

The use of HPI significantly reduces intraoperative hypotension in elderly patients undergoing pancreaticoduodenectomy, leading to a reduction in pulmonary and gastrointestinal complications. Further research is needed to assess its impact on overall postoperative morbidity and mortality.