Authors: Wang et al.
Journal: A & A Practice published: April 2026
Summary:
This systematic review and meta-analysis evaluated whether Hypotension Prediction Index-guided hemodynamic management improves postoperative organ outcomes in adult surgical patients. The Hypotension Prediction Index is an artificial intelligence-based tool designed to predict intraoperative hypotension before it occurs, allowing clinicians to treat patients earlier and potentially reduce hypotensive episodes.
The authors searched major medical databases from 1946 through August 8, 2025. They included randomized controlled trials involving adult surgical patients with invasive arterial monitoring. The studies compared HPI-guided perioperative hemodynamic management with standard care. The primary outcome was postoperative acute kidney injury. Secondary outcomes included myocardial injury, pneumonia, arrhythmia, stroke, postoperative cognitive dysfunction including delirium, surgical site infection, hospital length of stay, and mortality.
A total of 14 studies including 2,030 patients were included in the final analysis. HPI-guided management did not significantly reduce postoperative acute kidney injury compared with standard care. The risk ratio for acute kidney injury was 0.87, with a 95% confidence interval of 0.71 to 1.07.
The analysis did show a statistically significant reduction in postoperative myocardial injury in the HPI-guided group, with a risk ratio of 0.61. However, the authors noted that this finding was not robust when sensitivity analyses were performed. No significant differences were found for hospital length of stay, arrhythmia, stroke, cognitive dysfunction or delirium, surgical site infection, pneumonia, or mortality.
Why this matters:
This article suggests that although HPI-guided management may reduce intraoperative hypotension, that improvement does not clearly translate into better postoperative organ outcomes. The possible reduction in myocardial injury is interesting, but the result appears fragile and should be interpreted cautiously.
Take-home point:
HPI-guided hemodynamic management did not significantly reduce postoperative acute kidney injury or most other postoperative complications. It may reduce myocardial injury, but that finding was not strong enough to remain significant in sensitivity analysis.
Thank you to A & A Practice for publishing this article and allowing us to summarize it.