• Tetsuya Shimada, Barak Cohen, Karan Shah, Lauretta Mosteller, Mauro Bravo, Ilker Ince, EsaWael Ali SakrWASDepartment of General Anesthesia, Cleveland Clinic, Cleveland, OH, United States., Jacek Cywinski, Daniel I Sessler, Kurt Ruetzler, and Alparslan Turan.
• Department of OUTCOMES RESEARCH, Cleveland Clinic, Cleveland, OH, United States; Department of Anesthesiology, National Hospital Organization, Murayama Medical Center, Musashimurayama, Tokyo, Japan; Department of Anesthesiology, National Defense Medical College, Tokorozawa, Saitama, Japan.
• J Clin Anesth. 2021 Dec 1; 75: 110495.

Study ObjectiveTo test whether patients who experience hypotension in the post-anesthesia care unit or during surgery are most likely to experience hypotension on surgical wards.DesignA prediction study using data from two randomized controlled trials.SettingOperating room, post-anesthesia care unit, and surgical ward.Patients550 adult patients having abdominal surgery with ASA physical status I-IV.InterventionsBlood pressure measurement per routine intraoperatively, and with continuous non-invasive monitoring postoperatively.MeasurementsThe primary predictors were minimum mean arterial pressure (<60, <65, <70 and < 80 mmHg) and minimum systolic blood pressure (<70, <75, <80, <85 mmHg) in the post-anesthesia care unit. The secondary predictors were intraoperative minimum blood pressures with the same thresholds as the primary ones. Our outcome was ward hypotension defined as mean pressure < 70 mmHg or systolic pressure < 85 mmHg. A threshold was considered clinically useful if both sensitivity and specificity exceeded 0.75.Main ResultsMinimum mean and systolic pressures in the post-anesthesia care unit similarly predicted ward mean or systolic hypotension, with the areas under the curves near 0.74. The best performing threshold was mean pressure < 80 mmHg in the post-anesthesia care unit which had a sensitivity of 0.41 (95% confidence interval [CI], 0.35, 0.47) and specificity of 0.91 (95% CI, 0.87, 0.94) for ward mean pressure < 70 mmHg and a sensitivity of 0.44 (95% CI, 0.37, 0.51) and specificity of 0.88 (95% CI, 0.84, 0.91) for ward systolic pressure < 85 mmHg. The areas under the curves using intraoperative hypotension to predict ward hypotension were roughly similar at about 0.60, with correspondingly low sensitivity and specificity.ConclusionsIntraoperative hypotension poorly predicted ward hypotension. Pressures in the post-anesthesia care unit were more predictive, but the combination of sensitivity and specificity remained poor. Unless far better predictors are identified, all surgical inpatients should be considered at risk for postoperative hypotension.Copyright © 2021 Elsevier Inc. All rights reserved.

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