Chronic hypertension is seen in 30% of adults in the United States, and patients presenting with hypertension for elective surgery is an everyday occurrence in U.S. health care. Nonetheless, elective surgical procedures are commonly canceled due to elevated blood pressure on the day of surgery. However, a new study indicates that postponing surgery to treat elevated blood pressure doesn’t necessarily reduce preoperative cardiac risk.
“No universally accepted guidelines exist for managing surgical patients with hypertension,” said Michael O’Rourke, MD, assistant professor of anesthesiology and director of the Presurgical Anesthesia Screening Clinic at Loyola University Medical Center, in Maywood, Ill.
Dr. O’Rourke discussed his study at the 2016 joint meeting of the Society for Ambulatory Anesthesia and the American Society of Anesthesiologists. “We see that anesthesiologists have different approaches to patients presenting for ambulatory surgery with elevated blood pressure.”
Hypertension Prompts Differing Responses
As part of the study, Dr. O’Rourke sent an email and multiple-choice survey to the 124 anesthesia providers who provide perioperative care of surgical patients at Loyola University Medical Center.
Survey questions asked about the provider’s definition of perioperative hypertension and current practice for patients who show up for ambulatory elective surgery with elevated blood pressure.
For example, the provider could proceed with the procedure, check the patient’s blood pressure again and then proceed, cancel the case or send the patient to the emergency department.
In the survey, 65% of responders said they would proceed to the operating room (OR) for a patient with hypertension and a blood pressure of 165/105 mm Hg, whereas only 6.7% would proceed if the blood pressure was 185/115 mm Hg.
In addition, 53% of responders said they would proceed to the OR for a patient without hypertension and a blood pressure of 165/105 mm Hg, whereas only 4.4% would proceed if the blood pressure was 185/115 mm Hg. Variation about what defined perioperative hypertension also existed among providers.
“The findings were interesting in that attendings were less likely to cancel the procedure in five of the six scenarios, as compared with residents or CRNAs [certified registered nurse anesthetists],” Dr. O’Rourke said. “This is the first step in identifying what providers are doing in terms of canceling cases on the day of surgery.
“I hope this research is a first step toward better defining anesthesiologists’ views toward patients with elevated blood pressure on the day of surgery,” Dr. O’Rourke said. “If universal guidelines existed for management of patients presenting for surgery with elevated blood pressure, it would likely improve the quality of patient care and reduce surgical cancellations.”