Myocardial Injury and Postoperative Hypotension in the Recovery Room Are Not Correlated: A Retrospective Cohort Study.

Background

Hypotension is common during and after surgery and is known to be associated with myocardial injury. This study investigated whether hypotension in the recovery room after non-cardiac surgery is associated with myocardial injury.

Methods

In this retrospective cohort study, data were used from a clinical registry of patients aged 60 years or older undergoing intermediate-to-high-risk non-cardiac surgery. Patients admitted to the Intensive Care Unit or the high-dependency ward were excluded. Hypotension was characterized by the time-weighted average (TWA) below 75 mmHg mean arterial pressure (MAP) measured in the recovery room after surgery. Patients were divided into quartiles of increasing hypotension exposure, i.e., increasing TWA. The primary outcome was myocardial injury, defined as peak high-sensitivity troponin T over 50 ng/L within the first 3 postoperative days.

Results

In total, 2660 patients were analyzed. Hypotension in the recovery room was observed in 1119 (43.7%) of the patients while myocardial injury occurred in 198 (7.7%) patients. There was no association between increasing exposures of hypotension and myocardial injury (lowest TWA vs. highest TWA quartile: 7.9% vs. 9.0%, p = 0.65). Furthermore, there was no association between hypotension and 30-day mortality (highest vs. lowest quartile: 1.5% vs. 1.5%, p = 0.82). However, an association was noted at 1 year (9.8% vs. 14.7%, p = 0.02).

Conclusions

Hypotension in the recovery room after moderate-to-high-risk non-cardiac surgery is not associated with the development of myocardial injury.