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

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

Background: A multidisciplinary international working subgroup of the third Perioperative Quality Initiative consensus meeting appraised the evidence on the influence of preoperative arterial blood pressure and community cardiovascular medications on perioperative risk. 

Methods: A modified Delphi technique was used, evaluating papers published in MEDLINE on associations between preoperative numerical arterial pressure values or cardiovascular medications and perioperative outcomes. The strength of the recommendations was graded by National Institute for Health and Care Excellence guidelines. 

Results: Significant heterogeneity in study design, including arterial pressure measures and perioperative outcomes, hampered the comparison of studies. Nonetheless, consensus recommendations were that (i) preoperative arterial pressure measures may be used to define targets for perioperative management; (ii) elective surgery should not be cancelled based solely upon a preoperative arterial pressure value; (iii) there is insufficient evidence to support lowering arterial pressure in the immediate preoperative period to minimise perioperative risk; and (iv) there is insufficient evidence that any one measure of arterial pressure (systolic, diastolic, mean, or pulse) is better than any other for risk prediction of adverse perioperative events. 

Conclusions: Future research should define which preoperative arterial pressure values best correlate with adverse outcomes, and whether modifying arterial pressure in the preoperative setting will change the perioperative morbidity or mortality. Additional research should define optimum strategies for continuation or discontinuation of preoperative cardiovascular medications.

arterial pressure, haemodynamics, perioperative care, preoperative blood pressure, surgical risk
0007-0912
552-562
Sanders, Robert D.
2276714e-c77f-4957-a5e1-25cc4b677201
Hughes, Fintan
6508fd73-5eb4-4e16-a1c3-ae937b809523
Shaw, Andrew
6690c15c-4ace-4fc1-9069-253feaa14fa3
Thompson, Annemarie
54e611f6-ef67-48bc-add7-689cd7b7af2d
Bader, Angela
d0a29182-a5e7-41a8-8459-4fc02b873972
Hoeft, Andreas
091e7bcd-0f66-4dc4-9c6b-38e5248feb5d
Williams, David A.
094ce3d7-eb21-4c00-98b3-27d956747a60
Grocott, Michael P.W.
1e87b741-513e-4a22-be13-0f7bb344e8c2
Mythen, Monty G.
dd073ee5-677a-4838-a8a6-30cffee69aa8
Miller, Timothy E.
cf4306b3-a501-48ae-96fe-205472b398b1
Edwards, Mark R.
818201d5-7636-4292-9af8-7dd8bcd1fcb5
Perioperative Quality Initiative-3 Workgroup
Sanders, Robert D.
2276714e-c77f-4957-a5e1-25cc4b677201
Hughes, Fintan
6508fd73-5eb4-4e16-a1c3-ae937b809523
Shaw, Andrew
6690c15c-4ace-4fc1-9069-253feaa14fa3
Thompson, Annemarie
54e611f6-ef67-48bc-add7-689cd7b7af2d
Bader, Angela
d0a29182-a5e7-41a8-8459-4fc02b873972
Hoeft, Andreas
091e7bcd-0f66-4dc4-9c6b-38e5248feb5d
Williams, David A.
094ce3d7-eb21-4c00-98b3-27d956747a60
Grocott, Michael P.W.
1e87b741-513e-4a22-be13-0f7bb344e8c2
Mythen, Monty G.
dd073ee5-677a-4838-a8a6-30cffee69aa8
Miller, Timothy E.
cf4306b3-a501-48ae-96fe-205472b398b1
Edwards, Mark R.
818201d5-7636-4292-9af8-7dd8bcd1fcb5

Sanders, Robert D., Hughes, Fintan, Shaw, Andrew, Thompson, Annemarie, Bader, Angela, Hoeft, Andreas, Williams, David A., Grocott, Michael P.W., Mythen, Monty G., Miller, Timothy E. and Edwards, Mark R. , Perioperative Quality Initiative-3 Workgroup (2019) Perioperative Quality Initiative consensus statement on preoperative blood pressure, risk and outcomes for elective surgery. British Journal of Anaesthesia, 122 (5), 552-562. (doi:10.1016/j.bja.2019.01.018).

Record type: Article

Abstract

Background: A multidisciplinary international working subgroup of the third Perioperative Quality Initiative consensus meeting appraised the evidence on the influence of preoperative arterial blood pressure and community cardiovascular medications on perioperative risk. 

Methods: A modified Delphi technique was used, evaluating papers published in MEDLINE on associations between preoperative numerical arterial pressure values or cardiovascular medications and perioperative outcomes. The strength of the recommendations was graded by National Institute for Health and Care Excellence guidelines. 

Results: Significant heterogeneity in study design, including arterial pressure measures and perioperative outcomes, hampered the comparison of studies. Nonetheless, consensus recommendations were that (i) preoperative arterial pressure measures may be used to define targets for perioperative management; (ii) elective surgery should not be cancelled based solely upon a preoperative arterial pressure value; (iii) there is insufficient evidence to support lowering arterial pressure in the immediate preoperative period to minimise perioperative risk; and (iv) there is insufficient evidence that any one measure of arterial pressure (systolic, diastolic, mean, or pulse) is better than any other for risk prediction of adverse perioperative events. 

Conclusions: Future research should define which preoperative arterial pressure values best correlate with adverse outcomes, and whether modifying arterial pressure in the preoperative setting will change the perioperative morbidity or mortality. Additional research should define optimum strategies for continuation or discontinuation of preoperative cardiovascular medications.

Full text not available from this repository.

More information

Accepted/In Press date: 1 January 2019
e-pub ahead of print date: 2 March 2019
Published date: May 2019
Keywords: arterial pressure, haemodynamics, perioperative care, preoperative blood pressure, surgical risk

Identifiers

Local EPrints ID: 431940
URI: http://eprints.soton.ac.uk/id/eprint/431940
ISSN: 0007-0912
PURE UUID: 2f82e62e-79ff-4211-9d33-08d43f68fc1c
ORCID for Michael P.W. Grocott: ORCID iD orcid.org/0000-0002-9484-7581

Catalogue record

Date deposited: 21 Jun 2019 16:30
Last modified: 18 Feb 2021 17:12

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Contributors

Author: Robert D. Sanders
Author: Fintan Hughes
Author: Andrew Shaw
Author: Annemarie Thompson
Author: Angela Bader
Author: Andreas Hoeft
Author: David A. Williams
Author: Monty G. Mythen
Author: Timothy E. Miller
Author: Mark R. Edwards
Corporate Author: Perioperative Quality Initiative-3 Workgroup

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