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

Publication ,  Journal Article
McEvoy, MD; Gupta, R; Koepke, EJ; Feldheiser, A; Michard, F; Levett, D; Thacker, JKM; Hamilton, M; Grocott, MPW; Mythen, MG; Miller, TE ...
Published in: Br J Anaesth
May 2019

BACKGROUND: Postoperative hypotension and hypertension are frequent events associated with increased risk of adverse outcomes. However, proper assessment and management is often poorly understood. As a part of the PeriOperative Quality Improvement (POQI) 3 workgroup meeting, we developed a consensus document addressing this topic. The target population includes adult, non-cardiac surgical patients in the postoperative phase outside of the ICU. METHODS: A modified Delphi technique was used, evaluating papers published in MEDLINE examining postoperative blood pressure monitoring, management, and outcomes. Practice recommendations were developed in line with National Institute for Health and Care Excellence guidelines. RESULTS: Consensus recommendations were that (i) there is evidence of harm associated with postoperative systolic arterial pressure <90 mm Hg; (ii) for patients with preoperative hypertension, the threshold at which harm occurs may be higher than a systolic arterial pressure of 90 mm Hg; (iii) there is insufficient evidence to precisely define the level of postoperative hypertension above which harm will occur; (iv) a greater frequency of postoperative blood pressure measurement is likely to identify risk of harm and clinical deterioration earlier; and (v) there is evidence of harm from withholding beta-blockers, angiotensin receptor blockers, and angiotensin-converting enzyme inhibitors in the postoperative period. CONCLUSIONS: Despite evidence of associations with postoperative hypotension or hypertension with worse postoperative outcome, further research is needed to define the optimal levels at which intervention is beneficial, to identify the best methods and timing of postoperative blood pressure measurement, and to refine the management of long-term antihypertensive treatment in the postoperative phase.

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Published In

Br J Anaesth

DOI

EISSN

1471-6771

Publication Date

May 2019

Volume

122

Issue

5

Start / End Page

575 / 586

Location

England

Related Subject Headings

  • Risk Assessment
  • Prognosis
  • Postoperative Complications
  • Perioperative Care
  • Hypotension
  • Hypertension
  • Humans
  • Evidence-Based Medicine
  • Elective Surgical Procedures
  • Delphi Technique
 

Citation

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McEvoy, M. D., Gupta, R., Koepke, E. J., Feldheiser, A., Michard, F., Levett, D., … Postoperative blood pressure group, . (2019). Perioperative Quality Initiative consensus statement on postoperative blood pressure, risk and outcomes for elective surgery. Br J Anaesth, 122(5), 575–586. https://doi.org/10.1016/j.bja.2019.01.019
McEvoy, Matthew D., Ruchir Gupta, Elena J. Koepke, Aarne Feldheiser, Frederic Michard, Denny Levett, Julie K. M. Thacker, et al. “Perioperative Quality Initiative consensus statement on postoperative blood pressure, risk and outcomes for elective surgery.Br J Anaesth 122, no. 5 (May 2019): 575–86. https://doi.org/10.1016/j.bja.2019.01.019.
McEvoy MD, Gupta R, Koepke EJ, Feldheiser A, Michard F, Levett D, et al. Perioperative Quality Initiative consensus statement on postoperative blood pressure, risk and outcomes for elective surgery. Br J Anaesth. 2019 May;122(5):575–86.
McEvoy, Matthew D., et al. “Perioperative Quality Initiative consensus statement on postoperative blood pressure, risk and outcomes for elective surgery.Br J Anaesth, vol. 122, no. 5, May 2019, pp. 575–86. Pubmed, doi:10.1016/j.bja.2019.01.019.
McEvoy MD, Gupta R, Koepke EJ, Feldheiser A, Michard F, Levett D, Thacker JKM, Hamilton M, Grocott MPW, Mythen MG, Miller TE, Edwards MR, POQI-3 workgroup, POQI chairs, Grocott MP, Physiology group, Preoperative blood pressure group, Intraoperative blood pressure group, Postoperative blood pressure group. Perioperative Quality Initiative consensus statement on postoperative blood pressure, risk and outcomes for elective surgery. Br J Anaesth. 2019 May;122(5):575–586.
Journal cover image

Published In

Br J Anaesth

DOI

EISSN

1471-6771

Publication Date

May 2019

Volume

122

Issue

5

Start / End Page

575 / 586

Location

England

Related Subject Headings

  • Risk Assessment
  • Prognosis
  • Postoperative Complications
  • Perioperative Care
  • Hypotension
  • Hypertension
  • Humans
  • Evidence-Based Medicine
  • Elective Surgical Procedures
  • Delphi Technique