Raising Hypotension Treatment Thresholds during surgery fails to impact Postoperative Outcomes: Study
In a meta-analysis of randomized controlled trials focusing on the incidence of common postoperative complications with different treatment thresholds of hypotension, researchers aimed to address the controversy surrounding the optimal management of intraoperative hypotension. The study involved a systematic search of databases for studies conducted between 2014 and 2024 that compared various treatment thresholds of hypotension (low, moderate, and high) in non-cardiac, non-obstetric surgeries. Eight randomized controlled trials with 9108 participants were included in the analysis. The findings revealed no significant differences in postoperative complications between groups with moderate and high mean arterial pressure treatment thresholds. Length of hospital stay also showed no significant variance between the groups. The meta-analysis was limited by the lack of data on lower treatment thresholds of mean arterial pressure.
Importance of Hypotension Management
The study highlighted the importance of managing intraoperative hypotension due to its association with severe complications such as organ ischemia. Current therapeutic approaches involve the administration of vasoactive agents and fluid therapy to maintain hemodynamic stability. The results emphasized the necessity of careful control of hypotension treatment duration to ensure patient safety.
Optimal Threshold Uncertainty
Although the study confirmed the absence of significant differences in postoperative complications between moderate and high treatment thresholds, the optimal threshold for hypotension management remains uncertain. Further research is needed to clarify the impact of different treatment thresholds on clinical outcomes.
The study faced limitations regarding the individualized blood pressure thresholds in some studies, leading to challenges in establishing fixed criteria for grouping. Additionally, variability in clinical settings and the need for long-term follow-up data to assess the impact of various blood pressure thresholds on outcomes were highlighted as important considerations for future research.
Conclusion and Further Exploration
In conclusion, this meta-analysis suggested that a moderate treatment threshold of hypotension did not significantly differ in postoperative complications compared to a high treatment threshold. However, the study emphasized the importance of further exploration to address heterogeneity and the necessity of long-term follow-up data in assessing the impact of different blood pressure thresholds.
Key Points
- A meta-analysis of eight randomized controlled trials was conducted to investigate the impact of different treatment thresholds of hypotension on postoperative complications in non-cardiac, non-obstetric surgeries.
- The study found no significant differences in postoperative complications or length of hospital stay between groups with moderate and high mean arterial pressure treatment thresholds.
- Managing intraoperative hypotension is crucial due to its association with severe complications like organ ischemia, with current approaches utilizing vasoactive agents and fluid therapy to maintain hemodynamic stability.
- Despite confirming the lack of differences in complications between moderate and high treatment thresholds, the optimal threshold for hypotension management remains uncertain, calling for further research for clarity on clinical outcomes.
- Study limitations included challenges in establishing fixed criteria for grouping due to individualized blood pressure thresholds in some studies, as well as the importance of long-term follow-up data to evaluate the impact of blood pressure thresholds on outcomes.
- The meta-analysis suggested that a moderate treatment threshold of hypotension did not significantly differ in postoperative complications compared to a high treatment threshold, highlighting the need for future exploration to address heterogeneity and the importance of long-term follow-up data in assessing different blood pressure thresholds' impact.
Reference –
Guan-Chao Qin et al. (2025). Intraoperative Hypotension And Postoperative Risks In Non-Cardiac Surgery: A Meta-Analysis. *BMC Anesthesiology*, 25. https://doi.org/10.1186/s12871-025-02976-5
