Intraoperative haemodynamics and postoperative intensive care unit admission in older patients with cancer.
Anoushka M Afonso, Dahniel Sastow, Joshua B Cadwell and 3 others
PMID 34134558WHAT IT FOUND
Longer intraoperative time with systolic blood pressure above 180mmHg or heart rate above 100 beats per minute was associated with ICU admission within 30 days in older cancer patients undergoing surgery lasting at least two hours.
Key findings
01Forty-eight of 994 patients were admitted to the ICU within 30 days after surgery.
02Operation time of at least 240 minutes was associated with ICU admission.
03Each minute of time spent with systolic blood pressure above 180mmHg or heart rate above 100 beats per minute was associated with ICU admission.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a single institution record review, so the finding may not apply elsewhere. All patients were followed by a geriatrics service in a shared care model, which may differ from usual perioperative care. Only 48 of 994 patients had ICU admission, so further adjustment for other possible causes was limited. The study did not account for anti-hypertensive medications or intraoperative treatments before and after blood pressure and heart rate changes. Comorbid conditions were taken from hospital codes submitted within the first 48 hours of stay, which may not fully describe each patient. The analysis combined many cancer surgery types, so the association may be stronger or weaker for specific surgeries. This was an observational study, so it cannot show that changing intraoperative blood pressure or heart rate would prevent ICU admission.
Declared interests
The article metadata lists NIH and non-U.S. government research support. GWF disclosed personal fees and non-financial support from Edwards Life Sciences. AMA is a consultant for Pacira and Merck. All remaining authors declared no conflicts of interest.
The easy way to misread this
Do not conclude that lowering intraoperative blood pressure or heart rate will prevent ICU admission. This was a retrospective observational study, not a randomised trial of treatment.