High Postoperative Blood Pressure After Cardiac Surgery Is Associated With Acute Kidney Injury and Death.

OBJECTIVES: Gaps and uncertainty exist regarding the understanding of optimal clinical goals for perioperative (ie, preoperative, intraoperative, and postoperative) blood pressure (BP) management in patients undergoing cardiac surgery and the consequences of achieving or failing to achieve those goals. In this setting, it is understood that preoperative hypertension is predictive of poor postoperative outcomes, with a growing appreciation that current, clinically acceptable changes in intraoperative BP also may be associated independently with adverse short- and long-term outcomes. In contrast, the impact of postoperative BP on outcomes after cardiac surgery remains less clear. DESIGN: This study was a retrospective outcome analysis. SETTING: The study included all cardiac surgery patients cared for at a single institution over a 7-year period. Consequences of the success or failure of meeting postoperative BP targets on medical outcomes and health resource utilization were evaluated. RESULTS: The study comprised 5,225 patients. Hypertensive postoperative patients experienced a higher in-hospital mortality rate compared with matched-case normotensive patients (4.97% v 1.32%, p<0.001) and a longer hospital stay (p = 0.024). In hypertensive patients, serum creatinine levels from postoperative day 1 through postoperative day 7 were increased compared with baseline and postoperative renal dysfunction according to the Kidney Disease: Improving Global Outcomes criteria occurred significantly more often (25.3% v 19.7%, p = 0.027). CONCLUSIONS: Postoperative hypertension is associated with compromised outcome as reflected by higher mortality, longer length of stay, and higher incidence of renal dysfunction.

Duke Scholars

Author Solomon Aronson Anesthesiology, Cardiothoracic