Background

The relationship between postoperative adverse events and blood pressures in the preoperative period remains poorly understood. This study tested the hypothesis that day-of-surgery preoperative blood pressures are associated with postoperative adverse events.

Methods

The authors conducted a retrospective, observational study of adult patients having elective procedures requiring an inpatient stay between November 2017 and July 2021 at Vanderbilt University Medical Center to examine the independent associations between preoperative systolic and diastolic blood pressures (SBP, DBP) recorded immediately before anesthesia care and number of postoperative adverse events—myocardial injury, stroke, acute kidney injury, and mortality—while adjusting for potential confounders. The study used multivariable ordinal logistic regression to model the relationship.

Results

The analysis included 57,389 cases. The overall incidence of myocardial injury, stroke, acute kidney injury, and mortality within 30 days of surgery was 3.4% (1,967 events), 0.4% (223), 10.2% (5,871), and 2.1% (1,223), respectively. The independent associations between both SBP and DBP measurements and number of postoperative adverse events were found to be U-shaped, with greater risk both above and less than SBP 143 mmHg and DBP 86 mmHg—the troughs of the curves. The associations were strongest at SBP 173 mmHg (adjusted odds ratio, 1.212 vs. 143 mmHg; 95% CI, 1.021 to 1.439; P = 0.028), SBP 93 mmHg (adjusted odds ratio, 1.339 vs. 143 mmHg; 95% CI, 1.211 to 1.479; P < 0.001), DBP 106 mmHg (adjusted odds ratio, 1.294 vs. 86 mmHg; 95% CI, 1.003 to 1.17671; P = 0.048), and DBP 46 mmHg (adjusted odds ratio, 1.399 vs. 86 mmHg; 95% CI, 1.244 to 1.558; P < 0.001).

Conclusions

Preoperative blood pressures both less than and above a specific threshold were independently associated with a higher number of postoperative adverse events, but the data do not support specific strategies for managing patients with low or high blood pressure on the day of surgery.

Editor’s Perspective
What We Already Know about This Topic
  • A diagnosis of hypertension is a risk factor for many adverse cardiovascular events
  • Among patients with or without a diagnosis of hypertension, the specific day of surgery blood pressure thresholds that are associated with adverse events remain poorly studied
What This Article Tells Us That Is New
  • Electronic health record data demonstrated that among 57,389 patients studied at a single center, the overall incidence of myocardial injury, stroke, acute kidney injury, and mortality within 30 days of surgery was 3.4% (1,967 events), 0.4% (223), 10.2% (5,871), and 2.1% (1,223)
  • Systolic blood pressures above and less than 143 mmHg and diastolic blood pressures above and less than 86 mmHg were associated with a higher risk of these adverse events
  • Acute kidney injury demonstrated the most reproducible and reliable association with higher or lower preoperative blood pressure