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

Published

Journal Article

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

Duke Authors

Cited Authors

  • Sanders, RD; Hughes, F; Shaw, A; Thompson, A; Bader, A; Hoeft, A; Williams, DA; Grocott, MPW; Mythen, MG; Miller, TE; Edwards, MR; Perioperative Quality Initiative-3 Workgroup, ; POQI chairs, ; Physiology group, ; Preoperative blood pressure group, ; Intraoperative blood pressure group, ; Postoperative blood pressure group,

Published Date

  • May 2019

Published In

Volume / Issue

  • 122 / 5

Start / End Page

  • 552 - 562

PubMed ID

  • 30916006

Pubmed Central ID

  • 30916006

Electronic International Standard Serial Number (EISSN)

  • 1471-6771

Digital Object Identifier (DOI)

  • 10.1016/j.bja.2019.01.018

Language

  • eng

Conference Location

  • England