INCIDENCE AND RISK FACTORS OF INTRAOPERATIVE HYPOTENSION DURING PROLONGED SURGICAL PROCEDURES

Abstract

One of the comorbidities of noncardiac surgery has been identified as intraoperative hypotension (IOH), which in itself has been shown to be associated with poor postoperative outcomes, and heart injury and acute kidney injury (AKI). Mechanistic connections between procedural time, Not fully defined is hemodynamic instability, and end organ injury may be a significant cause of IOH, and the time spent in surgery is a potentially significant factor. This retrospective cohort study used 1,847 adult patients who had non-emerging, non-cardiac surgery and were placed on general anesthesia at a community hospital, as their sample. The length of the surgeries was the primary exposure, which was a continuous variable and discrete variable. The main outcome was the time-weighted average of less than 65mmHg of mean arterial pressure (TWA 65), a total of the IOH load. The secondary outcome was the AKI (KDIGO criteria) and heart damage (troponin I > 45 ngL). These models were multivariate regression, limited cubic spline modelling and mediation analysis. The incidences of IOH were 67.8% and TWA median of 0.42 mmHgminmin was 0.42 mmHgminmin. The time of surgery was non-linear to TWA 65, high inflexion point = 210 minutes (p non-linearity < 0.001). The highest length of stay (215 minutes and above) the patients experienced a 23.1 incidence in AKI versus lowest quartile (8.8) (adjusted OR 2.87, 95% CI: 2.123.89). The mediation analysis found that 47.6% of the total effect of surgical time on AKI was mediated (inefficiency indirect 0.16, p < 0.001). The age is 65 years and above, ASA status is 3 and above, hypertension, and prone positioning. The interaction (all interaction p < 0.05) was changed significantly. It immensely affects the long operating period on the postoperative renal outcomes and approximately half of the influence intermediary between the intraoperative hypotension burden. High risk patients where there is a critical point at 210 minutes. The findings are used to apply tailored, preemptive hemodynamic treatment measures, particularly in the most vulnerable categories of patients, in such procedures, which are prolonged, to minimize the cumulative hypotensive burden and improve the perioperative outcomes.