• Wolf H Stapelfeldt, Ashish K Khanna, Andrew D Shaw, Apeksha V Shenoy, Seungyoung Hwang, Mitali Stevens, and Nathan J Smischney.
• Indiana University School of Medicine, Department of Anesthesia, 1130 West Michigan St., Indianapolis, IN 46202, USA; Richard L. Roudebush VA Medical Center, Department of Anesthesiology, 1481 W 10th St, Indianapolis, IN 46202, USA. Electronic address: wolf.stapelfeldt@va.gov.
• J Clin Anesth. 2021 Dec 1; 75: 110516.

Study ObjectiveDetermine if perioperative hypotension, a modifiable risk factor, is associated with increased postoperative healthcare resource utilization (HRU).DesignRetrospective cohort study.SettingMulticenter using the Optum® electronic health record database.PatientsPatients discharged to the ward after non-cardiac, non-obstetric surgeries between January 1, 2008 and December 31, 2017 with six months of data, before and after the surgical visit.Interventions/ExposurePerioperative hypotension, a binary variable (presence/absence) at an absolute MAP of ≤65-mmHg, measured during surgery and within 48-h after, to dichotomize patients with greater versus lesser hypotensive exposures.MeasurementsShort-term HRU defined by postoperative length-of-stay (LOS), discharge to a care facility, and 30-day readmission following surgery discharge. Mid-term HRU (within 6 months post-discharge) quantified via number of outpatient and emergency department (ED) visits, and readmission LOS.Main Results42,800 distinct patients met study criteria and 37.5% experienced perioperative hypotension. After adjusting for study covariates including patient demographics and comorbidities, patients with perioperative hypotension had: longer LOS (4.01 vs. 3.83 days; LOS ratio, 1.05; 95% CI, 1.04-1.06), higher odds of discharge to a care facility (OR, 1.18; 95% CI, 1.12-1.24; observed rate 22.1% vs. 18.1%) and of 30-day readmission (OR, 1.22; 95% CI, 1.11-1.33; observed rate 6.2% vs. 5.0%) as compared to the non-hypotensive population (all outcomes, p < 0.001). During 6-month follow-up, patients with perioperative hypotension showed significantly greater HRU regarding number of ED visits (0.34 vs. 0.31 visits; visit ratio, 1.10; 95% CI, 1.05-1.15) and readmission LOS (1.06 vs. 0.92 days; LOS ratio, 1.15; 95% CI, 1.07-1.24) but not outpatient visits (10.47 vs. 10.82; visit ratio, 0.97; 95% CI, 0.95-0.99) compared to those without hypotension. There was no difference in HRU during the 6-month period before qualifying surgery.ConclusionsWe report a significant association of perioperative hypotension with an increase in HRU, including additional LOS and readmissions, both important contributors to overall medical costs.Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.

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