Intraoperative Blood Pressure Management and Its Effects on Postoperative Delirium After Cardiac Surgery: A Single-Center Retrospective Cohort Study

Abstract

ObjectivesThere is accumulating evidence that blood pressure management might be associated with endorgan dysfunction after cardiac surgery. This study aimed to investigate the impact of intraoperative hypotension (IOH) on adverse neurological outcome and mortality.DesignSingle-center retrospective cohort study.SettingHeart and Diabetes Centre Bad Oeynhausen NRW, Ruhr-University BochumParticipantsThis retrospective cohort study included 31.315 adult patients who underwent elective cardiac surgery at our institution between January 2009 and December 2018.InterventionsAll cardiac surgery procedures except assist device implantation, organ transplantation and emergency surgery.Measurements and Main ResultsAdverse neurological outcome was defined as postoperative delirium and stroke. IOH was defined as mean arterial pressure (MAP) below 60 mmHg for > 2 minutes. The frequency of IOH episodes and the cumulative IOH duration were recorded. The association between IOH and adverse neurological outcome was examined with unadjusted statistical analysis and multiple logistic regression analysis. 849 patients (2.9 %) developed postoperative stroke and 2401 patients (7.7 %) developed postoperative delirium. The frequency of IOH episodes was independently associated with postoperative delirium in the multiple logistic regression analysis (OR 1.02, 95 % CI 1.003 - 1.03, p < 0.001), whereas there was no association of IOH and stroke.ConclusionThis large retrospective monocentre cohort study revealed that increased episodes of IOH are associated with the risk of developing postoperative delirium after cardiac surgery. This might have important clinical implications with respect to a careful and precise hemodynamic monitoring and proactive treatment, especially in patients with increased risk for postoperative delirium. There is accumulating evidence that blood pressure management might be associated with endorgan dysfunction after cardiac surgery. This study aimed to investigate the impact of intraoperative hypotension (IOH) on adverse neurological outcome and mortality. Single-center retrospective cohort study. Heart and Diabetes Centre Bad Oeynhausen NRW, Ruhr-University Bochum This retrospective cohort study included 31.315 adult patients who underwent elective cardiac surgery at our institution between January 2009 and December 2018. All cardiac surgery procedures except assist device implantation, organ transplantation and emergency surgery. Adverse neurological outcome was defined as postoperative delirium and stroke. IOH was defined as mean arterial pressure (MAP) below 60 mmHg for > 2 minutes. The frequency of IOH episodes and the cumulative IOH duration were recorded. The association between IOH and adverse neurological outcome was examined with unadjusted statistical analysis and multiple logistic regression analysis. 849 patients (2.9 %) developed postoperative stroke and 2401 patients (7.7 %) developed postoperative delirium. The frequency of IOH episodes was independently associated with postoperative delirium in the multiple logistic regression analysis (OR 1.02, 95 % CI 1.003 - 1.03, p < 0.001), whereas there was no association of IOH and stroke. This large retrospective monocentre cohort study revealed that increased episodes of IOH are associated with the risk of developing postoperative delirium after cardiac surgery. This might have important clinical implications with respect to a careful and precise hemodynamic monitoring and proactive treatment, especially in patients with increased risk for postoperative delirium.

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