Background:
Few studies have examined the association between intraoperative hypotension and postoperative nausea and vomiting (PONV), and no definitive conclusions have been established. This study investigated the association between intraoperative hypotension and PONV in patients undergoing laparoscopic gastrointestinal surgery.
Methods:
This secondary analysis of a randomized trial included adult patients at high risk for PONV undergoing laparoscopic gastrointestinal surgery. Intraoperative hypotension was quantified as a time-weighted average mean arterial pressure (TWA-MAP) <65 mmHg. Primary and secondary outcomes were PONV within 0–24 h and 25–120 h post-surgery, respectively. We assessed the association between intraoperative hypotension and outcomes using restricted cubic splines and multiple logistic regression models, adjusting for potential confounders. Sensitivity analyses were conducted using various MAP thresholds (70, 60, 55 mmHg) and metrics (area under the curve[AUC], duration) with similar models.
Results:
In total, 1,093 patients were included (median age 56 yr, 1,054(96.4%) female). The median[interquartile range] of TWA-MAP <65 mmHg, AUC, and duration of MAP <65 mmHg, were 0.03[0.00, 0.14] mmHg, 6.33[0.17, 30.17] mmHg·min, and 1.83[0.17, 7.00] min, respectively. The overall incidence of PONV within 0–24 h and 25–120 h post-surgery was 40.4% and 42.9% respectively. No exposure-response relationship was found between TWA-MAP <65 mmHg and either the primary or secondary outcome. Compared with the first tertile of TWA-MAP <65 mmHg, patients in the second and third tertiles did not have a higher risk of primary outcome (adjusted odds ratios [aOR] of 0.92 [95% CI, 0.67 to 1.24; P=0.569] and 0.95 [95% CI, 0.70 to 1.30; P=0.755], respectively) or secondary outcome (aOR of 1.05 [95% CI, 0.77 to 1.42; P=0.772] and 0.86 [95% CI, 0.63 to 1.18; P=0.360], respectively). Intraoperative hypotension was not associated with PONV in any sensitivity analyses.
Conclusion:
Intraoperative hypotension was not associated with PONV in patients at high risk of PONV who underwent laparoscopic gastrointestinal surgery.