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<p>Intraoperative hypotension (IOH) entails a health burden associated with a higher risk of organ ischemia and mortality, which can cause postoperative complications, such as acute kidney injury (AKI) or myocardial injury (MI). However, there is no unified definition of IOH, and the evidence regarding the association between IOH under different definitions and postoperative complications is still limited and uncertain. We searched PubMed, Web of Science and Embase databases from inception to December 24, 2024 and conducted an evidence map and a systematic review. To further confirm the threshold of IOH and explore the relationship between the duration of IOH and AKI/MI, we conducted sub-analyses by threshold of IOH, and dose-response meta-analyses based on the most commonly used threshold. A total of 81 studies involving 686,153 participants were included. We found that the publication rate of IOH and AKI/MI studies has been increasing in the last 10 years. In total, 52 unique studies were included for AKI and 12 studies were included for MI. The corresponding odds ratios (ORs) were 1.10 [95% Confidence Interval (CI), 1.08–1.12] and 1.27 (95% CI, 1.07–1.50), respectively. We further conducted sub-analysis by definition of IOH. The pooled ORs for AKI among mean arterial pressure (MAP) &lt; 65 mmHg, MAP &lt; 60 mmHg, MAP &lt; 55 mmHg and systolic blood pressure (SBP) &lt; 90 mmHg were 1.09 (95% CI, 1.04–1.13), 1.04 (95% CI, 1.00-1.07) , 2.22 (95% CI, 1.37–3.60) and 1.10 (95% CI, 0.99–1.23), respectively. The pooled ORs for MI among MAP &lt; 65 mmHg, MAP &lt; 60 mmHg, and SBP &lt; 90 mmHg were 1.22 (95% CI, 0.95–1.57), 1.17 (95% CI, 1.08–1.27), and 2.17 (95% CI, 0.48-9.81), respectively. When the threshold of IOH was 65 mmHg, there was a linear relationship between IOH and AKI. For every 10-minute increase, the risk of AKI in patients with IOH was 12% higher than the risk in patients without IOH. IOH is significantly associated with increased risks of postoperative AKI and MI, with stronger effects at lower MAP thresholds. The linear relationship between IOH duration and AKI risk highlights the need to minimize IOH. Targeted hemodynamic management strategies are essential to reduce postoperative complications, especially in high-risk patients.</p>

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The Effects of Intraoperative Hypotension on Postoperative Acute Kidney Injury and Myocardial Injury: A Systematic Review and modelling study

  • 期刊论文

  • 发表日期：

    2026年6月15日

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  • Jiaxin Zhao,
  • Xuan Li,
  • Yunfei Lv,
  • Rui Zhang,
  • Ang Li,
  • Gang Dong

摘要

Intraoperative hypotension (IOH) entails a health burden associated with a higher risk of organ ischemia and mortality, which can cause postoperative complications, such as acute kidney injury (AKI) or myocardial injury (MI). However, there is no unified definition of IOH, and the evidence regarding the association between IOH under different definitions and postoperative complications is still limited and uncertain. We searched PubMed, Web of Science and Embase databases from inception to December 24, 2024 and conducted an evidence map and a systematic review. To further confirm the threshold of IOH and explore the relationship between the duration of IOH and AKI/MI, we conducted sub-analyses by threshold of IOH, and dose-response meta-analyses based on the most commonly used threshold. A total of 81 studies involving 686,153 participants were included. We found that the publication rate of IOH and AKI/MI studies has been increasing in the last 10 years. In total, 52 unique studies were included for AKI and 12 studies were included for MI. The corresponding odds ratios (ORs) were 1.10 [95% Confidence Interval (CI), 1.08–1.12] and 1.27 (95% CI, 1.07–1.50), respectively. We further conducted sub-analysis by definition of IOH. The pooled ORs for AKI among mean arterial pressure (MAP) < 65 mmHg, MAP < 60 mmHg, MAP < 55 mmHg and systolic blood pressure (SBP) < 90 mmHg were 1.09 (95% CI, 1.04–1.13), 1.04 (95% CI, 1.00-1.07) , 2.22 (95% CI, 1.37–3.60) and 1.10 (95% CI, 0.99–1.23), respectively. The pooled ORs for MI among MAP < 65 mmHg, MAP < 60 mmHg, and SBP < 90 mmHg were 1.22 (95% CI, 0.95–1.57), 1.17 (95% CI, 1.08–1.27), and 2.17 (95% CI, 0.48-9.81), respectively. When the threshold of IOH was 65 mmHg, there was a linear relationship between IOH and AKI. For every 10-minute increase, the risk of AKI in patients with IOH was 12% higher than the risk in patients without IOH. IOH is significantly associated with increased risks of postoperative AKI and MI, with stronger effects at lower MAP thresholds. The linear relationship between IOH duration and AKI risk highlights the need to minimize IOH. Targeted hemodynamic management strategies are essential to reduce postoperative complications, especially in high-risk patients.