Intraoperative Hypotension and Related Risk Factors for Postoperative Mortality After Noncardiac Surgery in Elderly Patients: A Retrospective Analysis Report

Figures & data

Figure 1 The flow chart of patient enrollment. Control group (n=236), Observational group (n=118).

Table 1 Clinical Characteristics of Patients

	Control Group (n=236)	Observational Group (n=118)	Statistic	p value
Demographics
Age [M (P25, P75)]	71 (68–77)	72 (68–79)	−1.75	0.079
Male, n (%)	135 (57.20)	78 (66.10)	2.60	0.107
BMI [M (P25, P75)]	22.9 (21.0–25.4)	22.3 (19.8–24.8)	−1.77	0.076
ASA classification, n (%)			82.65	< 0.001*
I	9 (3.81)	1 (0.85)
II	173 (73.31)	37 (31.36)
III	51 (21.61)	54 (45.76)
IV	3 (1.27)	26 (22.03)
NYHA cardiac function, n (%)			5.08	0.079
I	29 (12.29)	10 (8.47)
II	161 (68.22)	73 (61.86)
III	46 (19.49)	35 (29.66)
Co-morbidity
Hypertension, n (%)	102 (43.22)	60 (50.85)	1.84	0.175
CHD, n (%)	38 (16.10)	24 (20.34)	0.98	0.323
Cerebral hernia, n (%)	1 (0.42)	8 (6.78)	12.83	< 0.001*
Arrhythmia, n (%)	28 (11.86)	11 (9.32)	0.52	0.471
Diabetes, n (%)	39 (16.53)	23 (19.49)	0.48	0.489
Renal dysfunction, n (%)	0 (0.00)	8 (6.78)	13.44	< 0.001*
COPD, n (%)	8 (3.39)	15 (12.82)	11.42	0.001*
Anemia, n (%)	19 (8.05)	6 (5.08)	1.05	0.304
Trauma, n (%)	3 (1.28)	14 (11.86)	19.21	< 0.001*
Malignant tumor, n (%)	67 (28.39)	31 (26.27)	0.18	0.675
Charlson index	1 (0, 2)	2 (1, 2)	−2.796	0.005*
Surgery information
Intraoperative Crystal liquid infusion (mL) [M (P25, P75)]	1250 (800, 1787.5)	1500 (675, 2162.5)	−0.839	0.401
Intraoperative Colloidal fluid infusion (mL) [M (P25, P75)]	500 (500, 500)	800 (500, 800)	−6.667	< 0.001*
Total intraoperative infusion (mL) [M (P25, P75)]	1800 (1400, 2400)	2375 (1575, 3200)	−3.899	< 0.001*
Intraoperative blood loss (mL) [M (P25, P75)]	20 (100, 200)	200 (100, 400)	−5.181	< 0.001*
Intraoperative blood transfusion volume (mL) [M (P25, P75)]	0 (0, 0)	0 (0, 732.5)	−4.896	< 0.001*
Intraoperative urine volume (mL) [M (P25, P75)]	200 (0, 500)	300 (100, 600)	−2.779	0.005*
Emergency operation, n (%)	21 (8.90)	58 (49.15)	73.53	< 0.001*
Operation time (min) [M (P25, P75)]	172.5(120, 238.75)	220 (143.75, 331.25)	−4.199	< 0.001*
PACU therapy, n (%)	157(66.53)	51(43.22)	17.63	< 0.001*
The use of vasoactive drugs, n (%)	68(28.81)	58(49.15)	14.20	< 0.001*
General anesthesia, n (%)	171(72.46)	112 (94.92)	24.75	< 0.001*
Intraoperative resuscitation, n (%)	1 (0.42)	5 (4.24)	4.768	0.029*
Type of surgery, n (%)			0.000	> 0.999
Neurosurgery	36 (15.25)	18 (15.25)
General surgery	32 (13.56)	16 (13.56)
Hepatobiliary Surgery	34 (14.41)	17 (14.41)
Urological surgery	28 (11.86)	14 (11.86)
Thoracic surgery	36 (15.25)	18 (15.25)
Orthopedic surgery	38 (16.10)	19 (16.10)
Obstetrics and Gynecology Surgery	32 (13.56)	16 (13.56)
Postoperative information
Postoperative ICU therapy, n (%)	4 (1.69)	23 (19.49)	32.883	< 0.001*
Postoperative hospitalization (days) [M (P25, P75)]	18 (11, 24)	9 (3, 23.5)	−4.952	< 0.001*
Second post-operative surgery, n (%)	6 (2.54)	11 (9.32)	7.909	0.005*
Postoperative organ dysfunction, n (%)
Postoperative AKI	2 (0.85)	9 (7.62)	9.863	0.002*
Postoperative ARDS	2 (0.85)	5 (4.24)	3.079	0.079
Postoperative delirium	1 (0.42)	3 (2.54)	1.549	0.213
Postoperative stroke	0 (0.00)	4 (3.39)	8.881	0.012*

Note: *p < 0.05 was statistically significant.

Abbreviations: BMI, body mass index; ASA, American Society of Anesthesiologists; NYHA, New York Heart Association; CHD, coronary heart disease; COPD, chronic obstructive pulmonary disease; PACU, postanesthesia care unit; ICU, intensive care unit; AKI, acute kidney injury; ARDS, acute respiratory distress syndrome.

Table 2 Percentage of Cumulative Duration of MAP in Total Operation Time [%, M (P25, P75)]

Group	≤ 55 mmHg	> 55 ~ 60 mmHg	> 60 ~ 65 mmHg	> 65 ~ 70 mmHg	> 71 ~ 75 mmHg	> 75 mmHg
Observational group	0 (0,1.84)	0 (0,4.13)	4.92 (0,10.78)	8.82 (1.44, 15.94)	12.27 (4.42, 19.34)	63.78 (44.23,90.38)
Control group	0 (0, 0)	0 (0,1.58)	0 (0,5.88)	4.23 (0,14.49)	8.45 (0,17.17)	79.67 (55.02, 98.24)

Table 3 Percentage of SBP Cumulative Duration in Total Operation Time [%, M (P25, P75)]

Group	≤ 80 mmHg	> 80 ~ 90 mmHg	> 90 ~ 100 mmHg	> 100 ~ 110 mmHg	> 110 ~ 120 mmHg	> 120 mmHg
Observational group	0 (0,2.42)	0 (0, 6)	5.82 (0,16.80)	14.04 (4.82, 22.43)	15.21 (9.2, 25.86)	50.78 (25.27, 69.14)
Control group	0 (0,0.41)	0 (0,3.30)	4.51 (0,15.31)	12.29 (1.72, 25)	17 (7.14, 27.92)	50 (22.73, 81.7)

Table 4 Univariate Logistic Regression Analysis of Postoperative Mortality in Elderly Patients

	Regression Coefficient (B)	The Standard Deviation (SE)	Wald Value	P	The OR Value	95% CI
Age	0.197	0.151	1.710	0.191	1.218	0.906 ~ 1.637
Gender	0.378	0.235	2.587	0.108	1.459	0.921 ~ 2.311
Body mass index (BMI)	0.066	0.035	3.458	0.063	0.936	0.873 ~ 1.004
ASA classification	1.663	0.209	63.411	< 0.001*	5.276	3.504 ~ 7.946
NYHA cardiac function	0.436	0.202	4.675	0.031*	1.546	1.042 ~ 2.295
Hypertension	0.307	0.226	1.839	0.175	1.359	0.872 ~ 2.117
CHD	0.285	0.289	0.974	0.324	1.330	0.755 ~ 2.345
Cerebral hernia	2.839	1.067	7.078	0.008*	17.091	2.111 ~ 138.338
Arrhythmia	0.270	0.375	0.516	0.472	0.764	0.366 ~ 1.593
Diabetes	0.201	0.291	0.478	0.489	1.223	0.691 ~ 2.164
COPD	1.433	0.454	9.975	0.002*	4.191	1.722 ~ 10.199
Anemia	0.491	0.483	1.037	0.309	0.612	0.238 ~ 1.575
Trauma	2.343	0.647	13.109	< 0.001*	10.41	2.929 ~ 37.003
Malignant tumor	0.107	0.254	0.176	0.675	0.899	0.546 ~ 1.479
Blood pressure
MAP ≤ 55 mmHg	0.557	0.201	7.696	0.006*	1.745	1.178 ~ 2.587
55 < MAP ≤ 60 mmHg	0.357	0.179	3.996	0.046*	1.430	1.007 ~ 2.030
60 < MAP ≤ 65 mmHg	0.537	0.150	12.809	< 0.001*	1.712	1.275 ~ 2.297
65 < MAP ≤ 70 mmHg	0.381	0.134	8.013	0.005*	1.463	1.124 ~ 1.905
70 < MAP ≤ 75 mmHg	0.373	0.145	6.600	0.010*	1.452	1.092 ~ 1.929
MAP > 75 mmHg	1.061	0.527	4.050	0.044*	0.346	0.123 ~ 0.973
SBP ≤ 80 mmHg	0.413	0.205	4.069	0.044*	1.511	1.012 ~ 2.258
80 < SBP ≤ 90 mmHg	0.342	0.156	4.849	0.028*	1.408	1.038 ~ 1.910
90 < SBP ≤ 100 mmHg	0.094	0.133	0.500	0.480	1.098	0.847 ~ 1.425
100 < SBP ≤ 110 mmHg	0.252	0.144	3.058	0.080	1.286	0.970 ~ 1.705
110 < SBP ≤ 120 mmHg	0.168	0.165	1.027	0.311	1.183	0.855 ~ 1.635
SBP > 120 mmHg	0.198	0.229	0.748	0.387	1.219	0.778 ~ 1.912
General anesthesia	1.959	0.444	19.507	< 0.001*	7.096	2.974 ~ 16.929
Emergency operation	2.292	0.294	60.969	< 0.001*	9.897	5.567 ~ 17.594
PACU therapy	0.960	0.231	17.195	< 0.001*	0.383	0.243 ~ 0.603
The use of vasoactive drugs	0.871	0.234	13.889	< 0.001*	2.388	1.511 ~ 3.775
Intraoperative urinary volume	0.062	0.248	0.062	0.803	0.940	0.578 ~ 1.528
Intraoperative blood loss	2.950	0.400	54.278	< 0.001*	19.104	8.716 ~ 41.875
Intraoperative blood transfusion volume	0.683	0.277	6.093	0.014*	1.980	1.151 ~ 3.404

Note: *p < 0.05 was statistically significant.

Abbreviations: BMI, body mass index; ASA, American Society of Anesthesiologists; NYHA, New York Heart Association; CHD, coronary heart disease; COPD, chronic obstructive pulmonary disease; PACU, postanesthesia care unit; ICU, intensive care unit; AKI, acute kidney injury; ARDS, acute respiratory distress syndrome.

Table 5 Multivariate Logistic Regression Analysis of Postoperative Mortality in Elderly Patients

Variable	Regression Coefficient (B)	The Standard Deviation (SE)	Wald Value	P	The OR Value	95% CI
X1 Emergency operation	0.815	0.403	4.089	0.043	2.260	1.025~4.982
X2 ASA classification	1.086	0.278	15.276	< 0.001	2.963	1.719~5.109
X3 General anesthesia	2.761	0.570	23.428	< 0.001	15.819	5.171~48.391
X4 60mmHg < MAP ≤ 65mmHg	0.409	0.197	4.305	0.038	1.505	1.023~2.215
X5 COPD	1.415	0.569	6.186	0.013	4.117	1.350~12.557
X6 PACU therapy	−1.472	0.363	16.404	< 0.001	0.230	0.113~0.468
Constant	−5.893	0.911	41.828	< 0.001	0.003

Note:p < 0.05 was statistically significant.

Figure 2 The ROC curve of P value predicted by logistic regression mode and the area under the curve (AUC).