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Relationship between blood pressure stability and mortality in cardiac surgery patients: retrospective cohort study

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Abstract

Performance measurement variables can be applied in clinical practice to evaluate hemodynamic instability. This study aimed to evaluate the relationship between the performance measurement of mean arterial pressure during cardiac surgery using cardiopulmonary bypass and postoperative mortality. A retrospective cohort study of patients who underwent cardiac surgery requiring cardiopulmonary bypass between 2013 and 2016 was conducted. The median performance error (MDPE) and median absolute performance error (MDAPE) were calculated using the preoperative mean arterial pressure as a reference, and intraoperative mean arterial pressures as measured values. Multivariable logistic regression analyses were performed using performance measurement variables to predict 30-day mortality. Overall survival according to performance measurement variables was evaluated using Cox proportional hazard models and Kaplan–Meier survival curves were generated to compare survival probability. Among 1203 patients, 110 (9.1%) died after surgery, and the 30-day mortality rate was 2.3% (28/1203). After adjusting for confounders, MDPE and MDAPE were significant mean arterial pressure derived predictors of 30-day mortality and overall survival. Intraoperative hypotension measured by performance measurement variables was independently associated with 30-day and overall mortality after cardiac surgery requiring cardiopulmonary bypass. Kaplan–Meier survival curves showed lower survival probability in patients with higher MDAPE during the pre- and post- cardiopulmonary bypass periods (P < 0.001 by log-rank test). Intraoperative hypotension measured by performance measurement variables was independently associated with 30-day and overall mortality after cardiac surgery requiring CPB. We propose that performance measurement variables are useful for quantifying the degree of intraoperative hypotension and predicting survival following cardiac surgery.

Trial registration: ClinicalTrials.gov, identifier: NCT03785132.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

This study used clinical data retrieved from Seoul National University Hospital Patients Research Environment (SUPREME) system. The authors thank the Medical Research Collaborating Center for their advice concerning the statistical analyses.

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Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea

    Susie Yoon, Jung-bin Park, Jaehun Lee, Hyung-Chul Lee, Jae-Hyon Bahk & Youn Joung Cho

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  1. Susie Yoon
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  2. Jung-bin Park
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  3. Jaehun Lee
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  4. Hyung-Chul Lee
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  5. Jae-Hyon Bahk
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  6. Youn Joung Cho
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Contributions

Study conception and design (SY, YJC); Methodology: (SY, H-CL, J-HB); Formal analysis and investigation: (SY, H-CL, YJC; Writing—original draft preparation: (SY, YJC); Writing—review and editing: (SY, JP, JL, YJC); Resources: (JP, JL, H-CL); Supervision: (H-CL, J-HB, YJC).

Corresponding author

Correspondence to Youn Joung Cho.

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The authors declare that they have no conflict of interest.

Ethical approval

This retrospective cohort study was approved by the Institutional Review Board of Seoul National University Hospital (#1806-164-953; July 02 2018) with a waiver of informed consent.

Informed consent

This retrospective cohort study was approved with a waiver of informed consent.

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Yoon, S., Park, Jb., Lee, J. et al. Relationship between blood pressure stability and mortality in cardiac surgery patients: retrospective cohort study. J Clin Monit Comput 35, 931–942 (2021). https://doi.org/10.1007/s10877-020-00631-7

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  • DOI: https://doi.org/10.1007/s10877-020-00631-7

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