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Cohort study of preoperative blood pressure and risk of 30-day mortality after elective non-cardiac surgery.
Venkatesan, S; Myles, P R; Manning, H J; Mozid, A M; Andersson, C; Jørgensen, M E; Hardman, J G; Moonesinghe, S R; Foex, P; Mythen, M; Grocott, M P W; Sanders, R D.
Afiliación
  • Venkatesan S; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK.
  • Myles PR; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK.
  • Manning HJ; Department of Obstetrics and Gynaecology, University of Wisconsin, Madison, WI, USA.
  • Mozid AM; Department of Cardiology, Bristol Heart Institute, Bristol, UK.
  • Andersson C; Division of Cardiology, Department of Internal Medicine, Glostrup Hospital, University of Copenhagen, Denmark.
  • Jørgensen ME; Cardiovascular Research Center, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
  • Hardman JG; Department of Anaesthesia, University of Nottingham, Nottingham, UK.
  • Moonesinghe SR; Department of Anaesthesia, Surgical Outcomes Research Centre, University College London Hospital, London, UK.
  • Foex P; National Institute for Academic Anaesthesia's Health Services Research Centre, London, UK.
  • Mythen M; Nuffield Division of Anaesthetics, Oxford University Hospital, Oxford, UK.
  • Grocott MPW; Department of Anaesthesia, Surgical Outcomes Research Centre, University College London Hospital, London, UK.
  • Sanders RD; National Institute for Academic Anaesthesia's Health Services Research Centre, London, UK.
Br J Anaesth ; 119(1): 65-77, 2017 Jul 01.
Article en En | MEDLINE | ID: mdl-28633374
BACKGROUND: Preoperative blood pressure (BP) thresholds associated with increased postoperative mortality remain unclear. We investigated the relationship between preoperative BP and 30-day mortality after elective non-cardiac surgery. METHODS: We performed a cohort study of primary care data from the UK Clinical Practice Research Datalink (2004-13). Parsimonious and fully adjusted multivariable logistic regression models, including restricted cubic splines for numerical systolic and diastolic BP, for 30-day mortality were constructed. The full model included 29 perioperative risk factors, including age, sex, comorbidities, medications, and surgical risk scale. Sensitivity analyses were conducted for age (>65 vs <65 years old) and the timing of BP measurement. RESULTS: A total of 251 567 adults were included, with 589 (0.23%) deaths within 30 days of surgery. After adjustment for all risk factors, preoperative low BP was consistently associated with statistically significant increases in the odds ratio (OR) of postoperative mortality. Statistically significant risk thresholds started at a preoperative systolic pressure of 119 mm Hg (adjusted OR 1.02 [95% confidence interval (CI) 1.01-1.02]) compared with the reference (120 mm Hg) and diastolic pressure of 63 mm Hg [OR 1.24 (95% CI 1.03-1.49)] compared with the reference (80 mm Hg). As BP decreased, the OR of mortality risk increased. Subgroup analysis demonstrated that the risk associated with low BP was confined to the elderly. Adjusted analyses identified that diastolic hypertension was associated with increased postoperative mortality in the whole cohort. CONCLUSIONS: In this large observational study we identified a significant dose-dependent association between low preoperative BP values and increased postoperative mortality in the elderly. In the whole population, elevated diastolic, not systolic, BP was associated with increased mortality.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Presión Sanguínea / Procedimientos Quirúrgicos Electivos Tipo de estudio: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Br J Anaesth Año: 2017 Tipo del documento: Article Pais de publicación: Reino Unido

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Presión Sanguínea / Procedimientos Quirúrgicos Electivos Tipo de estudio: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Br J Anaesth Año: 2017 Tipo del documento: Article Pais de publicación: Reino Unido