Retrospective Cohort Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jun 27, 2024; 16(6): 1582-1591
Published online Jun 27, 2024. doi: 10.4240/wjgs.v16.i6.1582
Risk factors associated with intraoperative persistent hypotension in pancreaticoduodenectomy
Xing-Jun Wang, Xi-Chen Xuan, Zhao-Chu Sun, Shi Shen, Fan Yu, Na-Na Li, Xue-Chun Chu, Hui Yin, You-Li Hu
Xing-Jun Wang, Xi-Chen Xuan, Zhao-Chu Sun, Shi Shen, Fan Yu, Na-Na Li, Xue-Chun Chu, Hui Yin, You-Li Hu, Department of Anesthesia and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
Author contributions: Wang XJ, Sun ZC, and Hu YL contributed to study conception and design; Wang XJ, Xuan XC, Shen S, Yu F, Chu XC, and Yin H contributed to data collection; Wang XJ, Sun ZC, and Li NN contributed to data analysis and interpretation; Wang XJ and Hu YL drafted the manuscript; and all authors have reviewed and approved the final manuscript version.
Institutional review board statement: This study received approval from the Ethics Committee of the First Affiliated Hospital of Nanjing Medical University (Approval No. 2023-SR-890).
Informed consent statement: This research is a retrospective analysis utilizing anonymized patient data from the hospital system, posing no risk of harm to patients. An exemption from patient informed consent has been requested from the hospital’s ethics committee.
Conflict-of-interest statement: The authors have no financial conflicts of interest to declare.
Data sharing statement: Data supporting this study’s findings can be obtained upon request from the corresponding author and are not publicly accessible due to privacy and ethical considerations.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: You-Li Hu, FACE, MD, Associate Chief Physician, Associate Professor, Department of Anesthesia and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Gulou District, Nanjing 210029, Jiangsu Province, China. huyouli@njmu.edu.cn
Received: March 7, 2024
Revised: April 27, 2024
Accepted: May 16, 2024
Published online: June 27, 2024
Processing time: 114 Days and 14.5 Hours
Abstract
BACKGROUND

Intraoperative persistent hypotension (IPH) during pancreaticoduodenectomy (PD) is linked to adverse postoperative outcomes, yet its risk factors remain unclear.

AIM

To clarify the risk factors associated with IPH during PD, ensuring patient safety in the perioperative period.

METHODS

A retrospective analysis of patient records from January 2018 to December 2022 at the First Affiliated Hospital of Nanjing Medical University identified factors associated with IPH in PD. These factors included age, gender, body mass index, American Society of Anesthesiologists classification, comorbidities, medication history, operation duration, fluid balance, blood loss, urine output, and blood gas parameters. IPH was defined as sustained mean arterial pressure < 65 mmHg, requiring prolonged deoxyepinephrine infusion for > 30 min despite additional deoxyepinephrine and fluid treatments.

RESULTS

Among 1596 PD patients, 661 (41.42%) experienced IPH. Multivariate logistic regression identified key risk factors: increased age [odds ratio (OR): 1.20 per decade, 95% confidence interval (CI): 1.08-1.33] (P < 0.001), longer surgery duration (OR: 1.15 per additional hour, 95%CI: 1.05-1.26) (P < 0.01), and greater blood loss (OR: 1.18 per 250-mL increment, 95%CI: 1.06-1.32) (P < 0.01). A novel finding was the association of arterial blood Ca2+ < 1.05 mmol/L with IPH (OR: 2.03, 95%CI: 1.65-2.50) (P < 0.001).

CONCLUSION

IPH during PD is independently associated with older age, prolonged surgery, increased blood loss, and lower plasma Ca2+.

Keywords: Risk factors, Pancreaticoduodenectomy, Perioperative period, Intraoperative persistent hypotension, Retrospective cohort study

Core Tip: This study examines risk factors for intraoperative persistent hypotension (IPH) in pancreaticoduodenectomy. Key risk factors include patient age, prolonged surgery duration, greater blood loss, and lower calcium levels. Prompt recognition and early intervention can effectively mitigate IPH in these operations.