Hemodynamics, fluids & transfusion
Cumulative multi-threshold intraoperative blood pressure exposure patterns and postoperative mortality
Model performance · 30-day mortalityResult — go to the resultΔAUROC 0.028 95% CI 0.025–0.037Authors' conclusion
Multi-threshold MAP exposure captured mortality-associated information not represented by exposure below MAP 65 mmHg alone, complementing this clinical threshold. The multi-threshold analysis identified groups with distinct pressure-time exposure patterns, providing a basis for hemodynamic profiling and investigation of hypotension-related outcomes. External validation is needed to assess the reproducibility and discrimination of these groups in other populations, followed by prospective studies to determine whether management informed by these patterns improves outcomes.
Study context
- Population
- adults having non-cardiac, non-obstetric surgery
- Participants
- 388,407 patientsEvents: 1.49%
- Predictors
- Pressure-time burden and proportion of operative time across MAP thresholds from 50 to 150 mmHg (multi-threshold blood-pressure-only model), compared with a model restricted to exposure below MAP 65 mmHg
- Predicted outcome
- 30-day mortality
Methodological detailsperioperative electronic health record data, decision-tree analysis using recursive partitioning
- Perioperative electronic health record data
- Decision-tree analysis using recursive partitioning
Model performance
As reported in the abstract
ΔAUROC
0.028
95% CI 0.025–0.037
P < 0.001
Further findings
Observed mortality rates across terminal exposure groups
- Terminal exposure groups defined by complete combinations of MAP level and cumulative exposure had different observed mortality rates
Medication associations
- Medication associations varied across groups
- Medication associations were exploratory
Observed 30-day mortality by depth of hypotension and proportion of operative time below MAP thresholds
- Generally higher with deeper hypotension and a greater proportion of operative time spent below MAP thresholds
- The relationship was not uniformly monotonic
Original publication
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