• Marianne Agerskov, Anna Nicoline Wolfhagen Thusholdt, Jakob Højlund, Christian Sahlholdt Meyhoff, Henrik Sørensen, Sebastian Wiberg, Niels Henry Secher, and Bang FossNicolaiNDepartment of Anaesthesia, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark..
• Department of Anaesthesia, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark marianne.agerskov@regionh.dk.
• BMJ Open. 2019 Nov 21; 9 (11): e031249.

IntroductionPerioperative haemodynamic instability is associated with postoperative morbidity and mortality. Macrocirculatory parameters, such as arterial blood pressure and cardiac output are associated with poor outcome but may be uncoupled from the microcirculation during sepsis and hypovolaemia and may not be optimal resuscitation parameters. The peripheral perfusion index (PPI) is derived from the pulse oximetry signal. Reduced peripheral perfusion is associated with morbidity in critically ill patients and in patients following acute surgery. We hypothesise that a low intraoperative PPI is independently associated with postoperative complications and mortality.Methods And AnalysisWe plan to conduct a retrospective cohort study in approximately 2300 patients, who underwent acute non-cardiac surgery (1 November 2017 to 31 October 2018) at two Danish University Hospitals. Data will be collected from patient records including patient demographics, comorbidity and intraoperative haemodynamic values with PPI as the primary exposure variable, and postoperative complications and mortality within 30 and 90 days as outcome variables. We primarily assess association between PPI and outcome in multivariate regression models. Second, the predictive value of PPI for outcome, using area under the receiver operating characteristics curve is assessed.Ethics And DisseminationData will be reported according to the Strengthening the Reporting of Observational Studies in Epidemiology and results published in a peer-reviewed journal. The study is approved by the regional research ethics committee, storage and management of data has been approved by the Regional Data Protection Agency, and access to medical records is approved by the hospital board of directors (ClinicalTrials.gov registration no: NCT03757442).© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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