NDLI: Impact of intraoperative hypotension and blood pressure fluctuations on early postoperative delirium after non-cardiac surgery.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Hirsch, J. DePalma, G. Tsai, T. T. Sands, L. P. Leung, J. M.
Description	Country affiliation: United States Author Affiliation: Hirsch J ( Department of Anesthesia and Perioperative Care, University of California, San Francisco 94143-0648, USA jan.hirsch@ucsf.edu.); DePalma G ( Department of Statistics, Purdue University, West Lafayette, IN 47907-2069, USA.); Tsai TT ( Department of Anesthesia and Perioperative Care, University of California, San Francisco 94143-0648, USA.); Sands LP ( Department of Statistics, Purdue University, West Lafayette, IN 47907-2069, USA.); Leung JM ( Department of Anesthesia and Perioperative Care, University of California, San Francisco 94143-0648, USA.)
Abstract	INTRODUCTION: Postoperative delirium is common in older patients. Despite its prognostic significance, the pathophysiology is incompletely understood. Although many risk factors have been identified, no reversible factors, particularly ones potentially modifiable by anaesthetic management, have been identified. The goal of this prospective cohort study was to investigate whether intraoperative hypotension was associated with postoperative delirium in older patients undergoing major non-cardiac surgery. METHODS: Study subjects were patients >65 years of age, undergoing major non-cardiac surgery, who were enrolled in an ongoing prospective observational study of the pathophysiology of postoperative delirium. Intraoperative blood pressure was measured and predefined criteria were used to define hypotension. Delirium was measured by the Confusion Assessment Method on the first two postoperative days. Data were analysed using t-tests, two-sample proportion tests and ordered logistic regression multivariable models, including correction for multiple comparisons. RESULTS: Data from 594 patients with a mean age of 73.6 years (sd 6.2) were studied. Of these 178 (30%) developed delirium on day 1 and 176 (30%) on day 2. Patients developing delirium were older, more often female, had lower preoperative cognitive scores, and underwent longer operations. Relative hypotension (decreases by 20, 30, or 40%) or absolute hypotension [mean arterial pressure (MAP)<50 mm Hg] were not significantly associated with postoperative delirium, nor was the duration of hypotension (MAP<50 mm Hg). Conversely, intraoperative blood pressure variance was significantly associated with postoperative delirium. DISCUSSION: These results showed that increased blood pressure fluctuation, not absolute or relative hypotension, was predictive of postoperative delirium.
File Format	HTM / HTML
ISSN	00070912
e-ISSN	14716771
DOI	10.1093/bja/aeu458
Journal	British Journal of Anaesthesia
Issue Number	3
Volume Number	115
Language	English
Publisher	Oxford University Press
Publisher Date	2015-09-01
Publisher Place	Great Britain (UK)
Access Restriction	Open
Subject Keyword	Discipline Anesthesiology Blood Pressure Delirium Epidemiology Hypotension Intraoperative Complications Surgical Procedures, Operative Cohort Studies Comorbidity Postoperative Complications Prospective Studies Risk Factors Observational Study Research Support, N.i.h., Extramural Research Support, Non-u.s. Gov't
Content Type	Text
Resource Type	Article
Subject	Anesthesiology and Pain Medicine

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