• Manila Singh, Jessica Spence, Karan Shah, Andra E Duncan, Donna Kimmaliardjuk, Daniel I Sessler, and Andrej Alfirevic.
• Department of Anesthesiology, Ochsner Health, New Orleans, LA, USA.
• J Clin Anesth. 2025 Jan 1; 100: 111686111686.

Study ObjectiveTo evaluate the associations between high and low intraoperative time-weighted average mean arterial pressures before, during and after cardiopulmonary bypass on postoperative delirium.DesignSingle center retrospective cohort study.SettingOperating rooms and postoperative care units.Patients11,382 patients, 18 years of age or older who had cardiac surgery requiring cardiopulmonary bypass between January 2017 and December 2020 at the Cleveland Clinic Main Campus.InterventionsAll cardiac surgery requiring bypass except procedures requiring deep hypothermic circulatory arrest.MeasurementsPost operative delirium was assessed from 12 to 96 h postoperatively, using the Confusion Assessment Method and brief Confusion Assessment Methods. Hypotension and hypertension were defined as time-weighted average mean arterial pressure < 60 and > 80 mmHg.Main ResultsPostoperative delirium occurred in 678 (6.0 %) of 11,382 patients. Confounder-adjusted associations, using multivariable logistic regression models, between hypotension (time-weighted average mean arterial pressure < 60 mmHg) and hypertension (time-weighted average mean arterial pressure > 80 mmHg) and postoperative delirium were not statistically significant or clinically meaningful before, during, or after the cardiopulmonary bypass.ConclusionsThis large single-center cohort analysis found no evidence that exposure to high or low blood pressures during various intraoperative phases of cardiac surgery are associated with postoperative delirium.Copyright © 2024 Elsevier Inc. All rights reserved.

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