Period-dependent Associations between Hypotension during and for Four Days after Noncardiac Surgery and a Composite of Myocardial Infarction and Death: A Substudy of the POISE-2 Trial

Daniel I Sessler; Christian Meyhoff; Nicole M Zimmerman; Guangmei Mao; Kate Leslie; Skarlet M Vásquez; Packianathaswamy Balaji; Jesús Alvarez-Garcia; Alexandre B Cavalcanti; Joel L Parlow; Prashant V Rahate; Manfred D Seeberger; Bruno Gossetti; S A Walker; Rajendra K Premchand; Rikke M Dahl; Emmanuelle Duceppe; Reitze Rodseth; Fernando Botto; P J Devereaux

doi:10.1097/aln.0000000000001985

Period-dependent Associations between Hypotension during and for Four Days after Noncardiac Surgery and a Composite of Myocardial Infarction and Death: A Substudy of the POISE-2 Trial

Daniel I Sessler, Christian Meyhoff, Nicole M Zimmerman, Guangmei Mao, Kate Leslie, Skarlet M Vásquez, Packianathaswamy Balaji, Jesús Alvarez-Garcia, Alexandre B Cavalcanti, Joel L Parlow, Prashant V Rahate, Manfred D Seeberger, Bruno Gossetti, S A Walker, Rajendra K Premchand, Rikke M Dahl, Emmanuelle Duceppe, Reitze Rodseth, Fernando Botto, P J Devereaux

Department of Clinical Medicine

80 Citations (Scopus)

Abstract

Background: The relative contributions of intraoperative and postoperative hypotension to perioperative morbidity remain unclear. We determined the association between hypotension and a composite of 30-day myocardial infarction and death over three periods: (1) intraoperative, (2) remaining day of surgery, and (3) during the initial four postoperative days. Methods: This was a substudy of POISE-2, a 10,010-patient factorial-randomized trial of aspirin and clonidine for prevention of myocardial infarction. Clinically important hypotension was defined as systolic blood pressure less than 90 mmHg requiring treatment. Minutes of hypotension was the exposure variable intraoperatively and for the remaining day of surgery, whereas hypotension status was treated as binary variable for postoperative days 1 to 4. We estimated the average relative effect of hypotension across components of the composite using a distinct effect generalized estimating model, adjusting for hypotension during earlier periods. Results: Among 9,765 patients, 42% experienced hypotension, 590 (6.0%) had an infarction, and 116 (1.2%) died within 30 days of surgery. Intraoperatively, the estimated average relative effect across myocardial infarction and mortality was 1.08 (98.3% CI, 1.03, 1.12; P < 0.001) per 10-min increase in hypotension duration. For the remaining day of surgery, the odds ratio was 1.03 (98.3% CI, 1.01, 1.05; P < 0.001) per 10-min increase in hypotension duration. The average relative effect odds ratio was 2.83 (98.3% CI, 1.26, 6.35; P = 0.002) in patients with hypotension during the subsequent four days of hospitalization. Conclusions: Clinically important hypotension-A potentially modifiable exposure-was significantly associated with a composite of myocardial infarction and death during each of three perioperative periods, even after adjustment for previous hypotension.

Original language	English
Journal	Anesthesiology
Volume	128
Issue number	2
Pages (from-to)	317-327
Number of pages	11
ISSN	0003-3022
DOIs	https://doi.org/10.1097/aln.0000000000001985
Publication status	Published - 1 Feb 2018

Keywords

Aged
Comorbidity
Female
Humans
Hypotension/epidemiology
Intraoperative Complications/mortality
Male
Myocardial Infarction/epidemiology
Postoperative Complications/mortality
Surgical Procedures, Operative/statistics & numerical data

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Sessler, D. I., Meyhoff, C., Zimmerman, N. M., Mao, G., Leslie, K., Vásquez, S. M., Balaji, P., Alvarez-Garcia, J., Cavalcanti, A. B., Parlow, J. L., Rahate, P. V., Seeberger, M. D., Gossetti, B., Walker, S. A., Premchand, R. K., Dahl, R. M., Duceppe, E., Rodseth, R., Botto, F., & Devereaux, P. J. (2018). Period-dependent Associations between Hypotension during and for Four Days after Noncardiac Surgery and a Composite of Myocardial Infarction and Death: A Substudy of the POISE-2 Trial. Anesthesiology, 128(2), 317-327. https://doi.org/10.1097/aln.0000000000001985

Period-dependent Associations between Hypotension during and for Four Days after Noncardiac Surgery and a Composite of Myocardial Infarction and Death: A Substudy of the POISE-2 Trial. / Sessler, Daniel I; Meyhoff, Christian; Zimmerman, Nicole M et al.
In: Anesthesiology, Vol. 128, No. 2, 01.02.2018, p. 317-327.

Research output: Contribution to journal › Journal article › Research › peer-review

Sessler, DI, Meyhoff, C, Zimmerman, NM, Mao, G, Leslie, K, Vásquez, SM, Balaji, P, Alvarez-Garcia, J, Cavalcanti, AB, Parlow, JL, Rahate, PV, Seeberger, MD, Gossetti, B, Walker, SA, Premchand, RK, Dahl, RM, Duceppe, E, Rodseth, R, Botto, F & Devereaux, PJ 2018, 'Period-dependent Associations between Hypotension during and for Four Days after Noncardiac Surgery and a Composite of Myocardial Infarction and Death: A Substudy of the POISE-2 Trial', Anesthesiology, vol. 128, no. 2, pp. 317-327. https://doi.org/10.1097/aln.0000000000001985

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title = "Period-dependent Associations between Hypotension during and for Four Days after Noncardiac Surgery and a Composite of Myocardial Infarction and Death: A Substudy of the POISE-2 Trial",

abstract = "Background: The relative contributions of intraoperative and postoperative hypotension to perioperative morbidity remain unclear. We determined the association between hypotension and a composite of 30-day myocardial infarction and death over three periods: (1) intraoperative, (2) remaining day of surgery, and (3) during the initial four postoperative days. Methods: This was a substudy of POISE-2, a 10,010-patient factorial-randomized trial of aspirin and clonidine for prevention of myocardial infarction. Clinically important hypotension was defined as systolic blood pressure less than 90 mmHg requiring treatment. Minutes of hypotension was the exposure variable intraoperatively and for the remaining day of surgery, whereas hypotension status was treated as binary variable for postoperative days 1 to 4. We estimated the average relative effect of hypotension across components of the composite using a distinct effect generalized estimating model, adjusting for hypotension during earlier periods. Results: Among 9,765 patients, 42% experienced hypotension, 590 (6.0%) had an infarction, and 116 (1.2%) died within 30 days of surgery. Intraoperatively, the estimated average relative effect across myocardial infarction and mortality was 1.08 (98.3% CI, 1.03, 1.12; P < 0.001) per 10-min increase in hypotension duration. For the remaining day of surgery, the odds ratio was 1.03 (98.3% CI, 1.01, 1.05; P < 0.001) per 10-min increase in hypotension duration. The average relative effect odds ratio was 2.83 (98.3% CI, 1.26, 6.35; P = 0.002) in patients with hypotension during the subsequent four days of hospitalization. Conclusions: Clinically important hypotension-A potentially modifiable exposure-was significantly associated with a composite of myocardial infarction and death during each of three perioperative periods, even after adjustment for previous hypotension.",

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T1 - Period-dependent Associations between Hypotension during and for Four Days after Noncardiac Surgery and a Composite of Myocardial Infarction and Death

T2 - A Substudy of the POISE-2 Trial

AU - Sessler, Daniel I

AU - Meyhoff, Christian

AU - Zimmerman, Nicole M

AU - Mao, Guangmei

AU - Leslie, Kate

AU - Vásquez, Skarlet M

AU - Balaji, Packianathaswamy

AU - Alvarez-Garcia, Jesús

AU - Cavalcanti, Alexandre B

AU - Parlow, Joel L

AU - Rahate, Prashant V

AU - Seeberger, Manfred D

AU - Gossetti, Bruno

AU - Walker, S A

AU - Premchand, Rajendra K

AU - Dahl, Rikke M

AU - Duceppe, Emmanuelle

AU - Rodseth, Reitze

AU - Botto, Fernando

AU - Devereaux, P J

PY - 2018/2/1

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N2 - Background: The relative contributions of intraoperative and postoperative hypotension to perioperative morbidity remain unclear. We determined the association between hypotension and a composite of 30-day myocardial infarction and death over three periods: (1) intraoperative, (2) remaining day of surgery, and (3) during the initial four postoperative days. Methods: This was a substudy of POISE-2, a 10,010-patient factorial-randomized trial of aspirin and clonidine for prevention of myocardial infarction. Clinically important hypotension was defined as systolic blood pressure less than 90 mmHg requiring treatment. Minutes of hypotension was the exposure variable intraoperatively and for the remaining day of surgery, whereas hypotension status was treated as binary variable for postoperative days 1 to 4. We estimated the average relative effect of hypotension across components of the composite using a distinct effect generalized estimating model, adjusting for hypotension during earlier periods. Results: Among 9,765 patients, 42% experienced hypotension, 590 (6.0%) had an infarction, and 116 (1.2%) died within 30 days of surgery. Intraoperatively, the estimated average relative effect across myocardial infarction and mortality was 1.08 (98.3% CI, 1.03, 1.12; P < 0.001) per 10-min increase in hypotension duration. For the remaining day of surgery, the odds ratio was 1.03 (98.3% CI, 1.01, 1.05; P < 0.001) per 10-min increase in hypotension duration. The average relative effect odds ratio was 2.83 (98.3% CI, 1.26, 6.35; P = 0.002) in patients with hypotension during the subsequent four days of hospitalization. Conclusions: Clinically important hypotension-A potentially modifiable exposure-was significantly associated with a composite of myocardial infarction and death during each of three perioperative periods, even after adjustment for previous hypotension.

AB - Background: The relative contributions of intraoperative and postoperative hypotension to perioperative morbidity remain unclear. We determined the association between hypotension and a composite of 30-day myocardial infarction and death over three periods: (1) intraoperative, (2) remaining day of surgery, and (3) during the initial four postoperative days. Methods: This was a substudy of POISE-2, a 10,010-patient factorial-randomized trial of aspirin and clonidine for prevention of myocardial infarction. Clinically important hypotension was defined as systolic blood pressure less than 90 mmHg requiring treatment. Minutes of hypotension was the exposure variable intraoperatively and for the remaining day of surgery, whereas hypotension status was treated as binary variable for postoperative days 1 to 4. We estimated the average relative effect of hypotension across components of the composite using a distinct effect generalized estimating model, adjusting for hypotension during earlier periods. Results: Among 9,765 patients, 42% experienced hypotension, 590 (6.0%) had an infarction, and 116 (1.2%) died within 30 days of surgery. Intraoperatively, the estimated average relative effect across myocardial infarction and mortality was 1.08 (98.3% CI, 1.03, 1.12; P < 0.001) per 10-min increase in hypotension duration. For the remaining day of surgery, the odds ratio was 1.03 (98.3% CI, 1.01, 1.05; P < 0.001) per 10-min increase in hypotension duration. The average relative effect odds ratio was 2.83 (98.3% CI, 1.26, 6.35; P = 0.002) in patients with hypotension during the subsequent four days of hospitalization. Conclusions: Clinically important hypotension-A potentially modifiable exposure-was significantly associated with a composite of myocardial infarction and death during each of three perioperative periods, even after adjustment for previous hypotension.

KW - Aged

KW - Comorbidity

KW - Female

KW - Humans

KW - Hypotension/epidemiology

KW - Intraoperative Complications/mortality

KW - Male

KW - Myocardial Infarction/epidemiology

KW - Postoperative Complications/mortality

KW - Surgical Procedures, Operative/statistics & numerical data

U2 - 10.1097/aln.0000000000001985

DO - 10.1097/aln.0000000000001985

M3 - Journal article

C2 - 29189290

SN - 0003-3022

VL - 128

SP - 317

EP - 327

JO - Anesthesiology

JF - Anesthesiology

IS - 2

ER -

Period-dependent Associations between Hypotension during and for Four Days after Noncardiac Surgery and a Composite of Myocardial Infarction and Death: A Substudy of the POISE-2 Trial

Abstract

Keywords

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