• Na-Ping Chen, Ya-Wei Li, Shuang-Jie Cao, Yue Zhang, Chun-Jing Li, Wei-Jie Zhou, Mo Li, Ya-Ting Du, Yu-Xiu Zhang, Mao-Wei Xing, Jia-Hui Ma, Dong-Liang Mu, and Dong-Xin Wang.
• The Department of Anesthesiology, Peking University First Hospital, Beijing, China. Electronic address: chennaping@bjmu.edu.cn.
• J Clin Anesth. 2024 Oct 1; 97: 111520111520.

Study ObjectiveTo assess the association of intraoperative hypotension with long-term survivals in older patients after major noncardiac surgery mainly for cancer.DesignA secondary analysis of databases from three randomized trials with long-term follow-up.SettingThe underlying trials were conducted in 17 tertiary hospitals in China.PatientsPatients aged 60 to 90 years who underwent major noncardiac thoracic or abdominal surgeries (≥ 2 h) in a single center were included in this analysis.ExposuresRestricted cubic spline models were employed to determine the lowest mean arterial pressure (MAP) threshold that was potentially harmful for long-term survivals. Patients were arbitrarily divided into three groups according to the cumulative duration or area under the MAP threshold. The association between intraoperative hypotension exposure and long-term survivals were analyzed with the Cox proportional hazard regression models.MeasurementsOur primary endpoint was overall survival. Secondary endpoints included recurrence-free and event-free survivals.Main ResultsA total of 2664 patients (mean age 69.0 years, 34.9% female sex, 92.5% cancer surgery) were included in the final analysis. MAP < 60 mmHg was adopted as the threshold of intraoperative hypotension. Patients were divided into three groups according to duration under MAP < 60 mmHg (<1 min, 1-10 min, and > 10 min) or area under MAP <60 mmHg (< 1 mmHg⋅min, 1-30 mmHg⋅min, and > 30 mmHg⋅min). After adjusting confounders, duration under MAP < 60 mmHg for > 10 min was associated with a shortened overall survival when compared with the < 1 min patients (adjusted hazard ratio [HR] 1.31, 95% confidence interval [CI] 1.09 to 1.57, P = 0.004); area under MAP < 60 mmHg for > 30 mmHg⋅min was associated with a shortened overall survival when compared with the < 1 mmHg⋅min patients (adjusted HR 1.40, 95% CI 1.16 to 1.68, P < 0.001). Similar associations exist between duration under MAP < 60 mmHg for > 10 min or area under MAP < 60 mmHg for > 30 mmHg⋅min and recurrence-free or event-free survivals.ConclusionsIn older patients who underwent major noncardiac surgery mainly for cancer, intraoperative hypotension was associated with worse overall, recurrence-free, and event-free survivals.Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

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