Perioperative Quality Initiative consensus statement on postoperative blood pressure, risk and outcomes for elective surgery

McEvoy, Matthew D., Gupta, Ruchir, Koepke, Elena J., Feldheiser, Aarne, Michard, Frederic, Levett, Denny, Thacker, Julie K.M., Hamilton, Mark, Grocott, Michael P.W., Mythen, Monty G., Miller, Timothy E. and Edwards, Mark R. , Physiology group, Intraoperative blood pressure group, Postoperative blood pressure group, POQI-3 workgroup and POQI chairs (2019) Perioperative Quality Initiative consensus statement on postoperative blood pressure, risk and outcomes for elective surgery. British Journal of Anaesthesia, 122 (5), 575-586. (doi:10.1016/j.bja.2019.01.019).

Abstract

Background: Postoperative hypotension and hypertension are frequent events associated with increased risk of adverse outcomes. However, proper assessment and management is often poorly understood. As a part of the PeriOperative Quality Improvement (POQI) 3 workgroup meeting, we developed a consensus document addressing this topic. The target population includes adult, non-cardiac surgical patients in the postoperative phase outside of the ICU.

Methods: A modified Delphi technique was used, evaluating papers published in MEDLINE examining postoperative blood pressure monitoring, management, and outcomes. Practice recommendations were developed in line with National Institute for Health and Care Excellence guidelines.

Results: Consensus recommendations were that (i) there is evidence of harm associated with postoperative systolic arterial pressure <90 mm Hg; (ii) for patients with preoperative hypertension, the threshold at which harm occurs may be higher than a systolic arterial pressure of 90 mm Hg; (iii) there is insufficient evidence to precisely define the level of postoperative hypertension above which harm will occur; (iv) a greater frequency of postoperative blood pressure measurement is likely to identify risk of harm and clinical deterioration earlier; and (v) there is evidence of harm from withholding beta-blockers, angiotensin receptor blockers, and angiotensin-converting enzyme inhibitors in the postoperative period.

Conclusions: Despite evidence of associations with postoperative hypotension or hypertension with worse postoperative outcome, further research is needed to define the optimal levels at which intervention is beneficial, to identify the best methods and timing of postoperative blood pressure measurement, and to refine the management of long-term antihypertensive treatment in the postoperative phase.

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Contributors

Author: Michael P.W. Grocott

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