Risk factors associated with intraoperative persistent hypotension in pancreaticoduodenectomy

doi:10.4240/wjgs.v16.i6.1582

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World Journal of Gastrointestinal Surgery

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1948-9366

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

World J Gastrointest Surg. Jun 27, 2024; 16(6): 1582-1591
Published online Jun 27, 2024. doi: 10.4240/wjgs.v16.i6.1582

Table 1 Baseline characteristics, n (%)

	Total (n = 1596)	Intraoperative persistent hypotension (n = 661)	Non-intraoperative persistent hypotension (n = 935)	P value
Age, yr, median (IQR)	64.0 (56.0-70.0)	65.0 (57.0-70.0)	63.0 (55.0-69.5)	0.001
Age, yr				0.030
≤ 40	50 (3.13)	16 (2.42)	34 (3.63)
41-50	135 (8.45)	51 (7.71)	84 (8.98)
51-60	422 (26.44)	152 (23.0)	270 (28.87)
61-70	631 (39.53)	283 (42.81)	348 (37.21)
> 70	358 (22.43)	159 (24.05)	199 (21.28)
Sex				0.620
Male	957 (59.96)	401 (60.66)	556 (59.46)
Female	639 (40.03)	260 (39.33)	379 (40.53)
Body mass index, kg/m², median (IQR)	22.83 (20.89-24.77)	22.86 (20.81-24.91)	22.80 (20.97-24.64)	0.830
ASA physical status				0.001
I	43 (2.69)	14 (2.11)	29 (31.00)
II	1255 (78.63)	500 (75.64)	755 (80.75)
III	298 (18.67)	147 (22.23)	151 (16.15)
Basic diseases
Hypertension	539 (33.77)	242 (36.61)	297 (31.76)	< 0.001
Diabetes	312 (19.55)	134 (20.27)	178 (19.04)	< 0.001
Preoperative albumin level, g/L (IQR)	37.60 (35.50-40.80)	37.60 (35.10-40.30)	38.00 (35.90-41.20)	< 0.010
Preoperative blood gas analysis, median (IQR)
pH	7.45 (7.44-7.47)	7.46 (7.44-7.47)	7.45 (7.43-7.47)	0.100
PaCO₂ (mmHg)	38 (36-41)	39 (36-41)	39 (36-41)	0.270
HCO₃^- (mmol/L)	27.10 (25.90-28.40)	27.00 (25.80-28.20)	27.20 (25.90-28.50)	0.090
Hb (mmol/L)	12.50 (11.20-13.60)	12.50 (11.00-13.60)	12.50 (11.20-13.60)	0.250
Lac (mmol/L)	0.90 (0.70-1.10)	0.90 (0.70-1.20)	0.90 (0.70-1.10)	0.360
Ca²⁺ (mmol/L)	1.11 (1.06-1.15)	1.11 (1.07-1.14)	1.11 (1.06-1.15)	0.470
Glu (mmol/L)	6.20 (5.40-7.60)	6.20 (5.40-7.70)	6.10 (5.30-7.50)	0.270

IQR: Interquartile range; pH: Arterial plasma pH; PaCO₂: Arterial carbon dioxide partial pressure; HCO₃: Plasma bicarbonate ions; Hb: Arterial hemoglobin; Lac: Arterial plasma lactate; Ca²⁺: Arterial plasma calcium ions; Glu: Arterial blood glucose concentration; ASA: American Society of Anesthesiologists.

Table 2 Comparison of general conditions between two groups during surgery

	Total (n = 1596)	Intraoperative persistent hypotension (n = 661)	Non-intraoperative persistent hypotension (n = 935)	P value
Surgery time, h (IQR)	4.58 (3.87-5.48)	4.75 (4.07-5.83)	4.45 (3.78-4.49)	< 0.001
Total infusion, mL (IQR)	2800 (2300-3500)	3100 (2595-3700)	2760 (2300-3277)	< 0.001
Crystal liquid, mL (IQR)	1600 (1500-2100)	1600 (1500-2100)	1600 (1500-2000)	< 0.001
Colloidal liquid, mL (IQR)	1000 (700-1200)	1000 (700-1200)	1000 (700-1200)	0.015
Red blood cell infusion, mL (IQR)	0 (0-260)	0 (0-390)	0 (0-0)	< 0.001
Grading of red blood cell infusion, n (%)				< 0.001
1-259 mL	26 (1.62)	10 (1.51)	16 (1.71)
260-519 mL	218 (13.66)	115 (17.40)	103 (11.00)
520-779 mL	172 (10.78)	89 (13.46)	83 (8.88)
780-1039 mL	50 (3.13)	30 (4.54)	20 (2.13)
≥ 1040 mL	10 (0.63)	10 (1.51)	0 (0)
Plasma, mL (IQR)	0 (0-325)	0 (0-375)	0 (0-370)	< 0.001
Total output, mL (IQR)	800 (550-1200)	850 (550-1300)	750 (500-1150)	< 0.001
Blood loss, mL (IQR)	300 (200-500)	350 (200-600)	300 (200-400)	< 0.001
Grading of blood loss, n (%)				< 0.001
< 250 mL	639 (40.04)	200 (30.26)	439 (46.95)
250-499 mL	510 (31.95)	215 (32.53)	295 (31.55)
500-749 mL	258 (16.17)	139 (21.03)	119 (12.73)
750-999 mL	107 (6.70)	52 (7.87)	55 (5.88)
≥ 1000 mL	82 (5.14)	55 (8.32)	27 (2.89)
Intraoperative urine output, mL (IQR)	400 (300-650)	400 (300-700)	400 (250-350)	0.054
Intraoperative blood gas analysis, median (IQR)
pH	7.38 (7.35-7.42)	7.38 (7.35-7.41)	7.38 (7.36-7.42)	< 0.001
PaCO₂ (mmHg)	41 (38-44)	41 (38-44)	42 (39-44)	0.270
HCO₃ (mmol/L)	25.00 (23.70-25.90)	24.60 (23.40-25.80)	25.00 (24.00-25.90)	< 0.001
Hb (mmol/L)	11.00 (10.20-11.90)	11.00 (9.90-11.90)	11.00 (10.20-11.90)	0.190
Lac (mmol/L)	1.00 (0.80-1.20)	1.00 (0.80-1.30)	1.00 (0.80-1.10)	< 0.001
Ca²⁺ (mmol/L)	1.06 (1.02-1.10)	1.05 (1.01-1.09)	1.07 (1.03-1.11)	< 0.001
Glu (mmol/L)	8.90 (7.70-10.00)	9.35 (7.90-10.4)	8.90 (7.50-9.80)	< 0.001
Glu _mean (mmol/L)	7.18 (6.46-8.30)	7.26 (6.54-8.45)	7.13 (6.41-8.17)	0.023
Glu _cv (%)	28 (20-36)	29 (21-36)	27 (19-35)	0.002
Ca²⁺ level, n (%)				< 0.001
Ca²⁺ ≤ 1.05 mmol/L	735 (46.05)	375 (56.73)	360 (38.50)
Ca²⁺ > 1.05 mmol/L	861 (53.95)	286 (43.27)	575 (61.50)

Glu _mean: The patient’s blood glucose at the time of hospital admission, preoperative blood glucose level, and blood glucose level recorded 3 h into the surgical procedure; Glu _cv: The coefficient of variation of blood glucose.

Citation: Wang XJ, Xuan XC, Sun ZC, Shen S, Yu F, Li NN, Chu XC, Yin H, Hu YL. Risk factors associated with intraoperative persistent hypotension in pancreaticoduodenectomy. World J Gastrointest Surg 2024; 16(6): 1582-1591
URL: https://www.wjgnet.com/1948-9366/full/v16/i6/1582.htm
DOI: https://dx.doi.org/10.4240/wjgs.v16.i6.1582