Postoperative Hypotension and Surgical Site Infections After Colorectal Surgery

A Retrospective Cohort Study

Huseyin O. Yilmaz, Rovnat Babazade, Steve Leung, Nicole M. Zimmerman, Natalya Makarova, Wael Saasouh, Luca Stocchi, Emre Gorgun, Daniel I. Sessler, Alparslan Turan

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Hypotension compromises local tissue perfusion, thereby reducing tissue oxygenation. Hypotension might thus be expected to promote infection. Hypotension on surgical wards, while usually less severe than intraoperative hypotension, is common and often prolonged. In this retrospective cohort study, we tested the hypotheses that there is an association between surgical site infections and low postoperative time-weighted average mean arterial pressure and/or postoperative minimum mean arterial pressure.

METHODS: We considered patients who had colorectal surgery lasting ≥1 hour at the Cleveland Clinic between 2009 and 2013. We defined blood pressure exposures as time-weighted average (primary) and minimum mean arterial pressure (secondary) within 72 hours after surgery. We assessed associations between continuous blood pressure exposures with a composite of deep and superficial surgical site infection using separate severity-weighted average relative effect generalized estimating equations models, each using an unstructured correlation structure and adjusting for potentially confounding variables.

RESULTS: A total of 5896 patients were eligible for analysis. Time-weighted mean arterial pressure and surgical site infection were not significantly associated, with an estimated odds ratio (95% CI) of 1.03 (0.99-1.08) for a 5-mm Hg decrease (P = .16). However, there was a significant inverse association between minimum postoperative mean arterial pressure and infection, with an estimated odds ratio of 1.08 (1.03-1.12) per 5-mm Hg decrease (P = .001).

CONCLUSIONS: Postoperative time-weighted mean arterial pressure was not associated with surgical site infection, but lowest postoperative mean arterial pressure was. Whether the relationship is causal remains to be determined.

Original languageEnglish (US)
Pages (from-to)1129-1136
Number of pages8
JournalAnesthesia and Analgesia
Volume127
Issue number5
DOIs
StatePublished - Nov 1 2018

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Surgical Wound Infection
Colorectal Surgery
Hypotension
Arterial Pressure
Cohort Studies
Retrospective Studies
Odds Ratio
Blood Pressure
Confounding Factors (Epidemiology)
Infection
Perfusion

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Postoperative Hypotension and Surgical Site Infections After Colorectal Surgery : A Retrospective Cohort Study. / Yilmaz, Huseyin O.; Babazade, Rovnat; Leung, Steve; Zimmerman, Nicole M.; Makarova, Natalya; Saasouh, Wael; Stocchi, Luca; Gorgun, Emre; Sessler, Daniel I.; Turan, Alparslan.

In: Anesthesia and Analgesia, Vol. 127, No. 5, 01.11.2018, p. 1129-1136.

Research output: Contribution to journalArticle

Yilmaz, HO, Babazade, R, Leung, S, Zimmerman, NM, Makarova, N, Saasouh, W, Stocchi, L, Gorgun, E, Sessler, DI & Turan, A 2018, 'Postoperative Hypotension and Surgical Site Infections After Colorectal Surgery: A Retrospective Cohort Study', Anesthesia and Analgesia, vol. 127, no. 5, pp. 1129-1136. https://doi.org/10.1213/ANE.0000000000003666
Yilmaz, Huseyin O. ; Babazade, Rovnat ; Leung, Steve ; Zimmerman, Nicole M. ; Makarova, Natalya ; Saasouh, Wael ; Stocchi, Luca ; Gorgun, Emre ; Sessler, Daniel I. ; Turan, Alparslan. / Postoperative Hypotension and Surgical Site Infections After Colorectal Surgery : A Retrospective Cohort Study. In: Anesthesia and Analgesia. 2018 ; Vol. 127, No. 5. pp. 1129-1136.
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N2 - BACKGROUND: Hypotension compromises local tissue perfusion, thereby reducing tissue oxygenation. Hypotension might thus be expected to promote infection. Hypotension on surgical wards, while usually less severe than intraoperative hypotension, is common and often prolonged. In this retrospective cohort study, we tested the hypotheses that there is an association between surgical site infections and low postoperative time-weighted average mean arterial pressure and/or postoperative minimum mean arterial pressure.METHODS: We considered patients who had colorectal surgery lasting ≥1 hour at the Cleveland Clinic between 2009 and 2013. We defined blood pressure exposures as time-weighted average (primary) and minimum mean arterial pressure (secondary) within 72 hours after surgery. We assessed associations between continuous blood pressure exposures with a composite of deep and superficial surgical site infection using separate severity-weighted average relative effect generalized estimating equations models, each using an unstructured correlation structure and adjusting for potentially confounding variables.RESULTS: A total of 5896 patients were eligible for analysis. Time-weighted mean arterial pressure and surgical site infection were not significantly associated, with an estimated odds ratio (95% CI) of 1.03 (0.99-1.08) for a 5-mm Hg decrease (P = .16). However, there was a significant inverse association between minimum postoperative mean arterial pressure and infection, with an estimated odds ratio of 1.08 (1.03-1.12) per 5-mm Hg decrease (P = .001).CONCLUSIONS: Postoperative time-weighted mean arterial pressure was not associated with surgical site infection, but lowest postoperative mean arterial pressure was. Whether the relationship is causal remains to be determined.

AB - BACKGROUND: Hypotension compromises local tissue perfusion, thereby reducing tissue oxygenation. Hypotension might thus be expected to promote infection. Hypotension on surgical wards, while usually less severe than intraoperative hypotension, is common and often prolonged. In this retrospective cohort study, we tested the hypotheses that there is an association between surgical site infections and low postoperative time-weighted average mean arterial pressure and/or postoperative minimum mean arterial pressure.METHODS: We considered patients who had colorectal surgery lasting ≥1 hour at the Cleveland Clinic between 2009 and 2013. We defined blood pressure exposures as time-weighted average (primary) and minimum mean arterial pressure (secondary) within 72 hours after surgery. We assessed associations between continuous blood pressure exposures with a composite of deep and superficial surgical site infection using separate severity-weighted average relative effect generalized estimating equations models, each using an unstructured correlation structure and adjusting for potentially confounding variables.RESULTS: A total of 5896 patients were eligible for analysis. Time-weighted mean arterial pressure and surgical site infection were not significantly associated, with an estimated odds ratio (95% CI) of 1.03 (0.99-1.08) for a 5-mm Hg decrease (P = .16). However, there was a significant inverse association between minimum postoperative mean arterial pressure and infection, with an estimated odds ratio of 1.08 (1.03-1.12) per 5-mm Hg decrease (P = .001).CONCLUSIONS: Postoperative time-weighted mean arterial pressure was not associated with surgical site infection, but lowest postoperative mean arterial pressure was. Whether the relationship is causal remains to be determined.

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