BACKGROUND:
Early postoperative cardiovascular complication rates are high and are associated with hemodynamic compromise. A large proportion of hypotensive episodes are missed with routine ward monitoring strategies due to low measurement frequency and nursing limitations.
OBJECTIVES:
The aim of this study was to determine the incidence of postoperative hypotension using a frequent monitoring strategy. Second, we looked at the relationship between postoperative hypotension and composite of mortality, non-fatal myocardial infarction, non-fatal stroke and new dialysis requirements. Finally, we sought to uncover significant predictors of postoperative hypotension.
METHODS:
Patients >45-years of age enrolled in the VISION Study were included in this sub-study. The COVIDIEN vital sign monitor was used to collect blinded hourly blood pressure measurements in patients post non-cardiac surgery until post-operative day three.
RESULTS:
1248 patients were included in this analysis. The three-day incidence of hypotension in the compliant intensively monitored group was almost twice higher (31.4% - 81/258 patients) than in the routine monitoring group, and the average delay in identifying a drop in BP under 90mmHg was almost 1.5 hours (87.5min) (IQR 21.3-153.3min). Severe hypotension (SBP <80mmHg) in the first three postoperative days, had the strongest association amongst all perioperative factors with the composite outcome of death, MI, stroke and new requirement for dialysis after non-cardiac surgery at 30 days [adjusted OR of 2.83 (95%CI, 1.25-6.44)]. Significant predictors of postoperative hypotension include a history of dialysis [adjusted OR 3.1 (95%CI, 1.14-12.96)], open surgery [adjusted OR 2.39 (95%CI, 1.57-3.62)], abdominal surgery [adjusted OR 1.79 (95%CI, 1.25-2.57)], and orthopedic surgery [adjusted OR 1.72 (95%CI, 1.112.74)].
CONCLUSION:
Early postoperative cardiovascular complication rates are high and are associated with hemodynamic compromise. A large proportion of hypotensive episodes are missed with routine ward monitoring strategies. / Thesis / Master of Science (MSc)
| Identifer | oai:union.ndltd.org:mcmaster.ca/oai:macsphere.mcmaster.ca:11375/25008 |
| Date | January 2019 |
| Creators | Dvirnik, Nazari |
| Contributors | Lamy, Andre, Devereaux, PJ, Whitlock, Richard, Health Research Methodology |
| Source Sets | McMaster University |
| Language | English |
| Detected Language | English |
| Type | Dataset |
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