What is the clinical evidence from this study?

Study design: Cohort. Population: Major open abdominal surgery (n=1461). Intervention: Intraoperative hypotension vs. Mean arterial pressure ≤60 mmHg for <1 minute. Primary outcome: Myocardial injury after non-cardiac surgery (MINS) within 30 days (OR 3.81, 95% CI 2.20-6.61).

May 9, 2026Frontiers in Medicine0 citationsOpen Access

Association between intraoperative hypotension and myocardial injury after major open abdominal surgery

Q: What are the key findings of this study?

In patients undergoing major open abdominal surgery, intraoperative hypotension with a mean arterial pressure ≤60 mmHg for ≥21 minutes was independently associated with an increased risk of myocardial injury (OR 3.81).

Q: What question did this study set out to answer?

This study aims to investigate the link between intraoperative hypotension and myocardial injury post major open abdominal surgery.

HJHaiying Ji RXRan Xia XTXingyu Tong

Key Result

In patients undergoing major open abdominal surgery, intraoperative hypotension with a mean arterial pressure ≤60 mmHg for ≥21 minutes was independently associated with an increased risk of myocardial injury (OR 3.81).

Key Points

This study aims to investigate the link between intraoperative hypotension and myocardial injury post major open abdominal surgery.
Retrospective cohort study conducted from June 2016 to July 2019
Invasive blood pressure monitoring used to assess intraoperative hypotension
Multivariable logistic regression analysis adjusted for clinical confounders
MINS occurred in 175 out of 1,461 patients (12.0%)
Longer durations of hypotension at MAP ≤60 mmHg significantly increased odds of MINS, OR ranging from 1.54 to 3.81 depending on duration
Lower MAP thresholds were associated with higher risk of MINS, with ORs of 3.66 for ≤65 mmHg, 3.81 for ≤60 mmHg, and 8.42 for ≤55 mmHg

Study Design

Type

Cohort (n=1,461)

Multicenter

Structured PICO

Does intraoperative hypotension increase the risk of myocardial injury after non-cardiac surgery in patients undergoing major open abdominal surgery?

Population

1,461 patients undergoing open abdominal surgery with invasive blood pressure monitoring

Intervention

Intraoperative hypotension (IOH) defined by absolute MAP thresholds (≤65, ≤60, and ≤55 mmHg) and relative MAP reductions (>30, >40, and >50% from baseline)

Comparator

Absence of intraoperative hypotension or shorter durations/less severe hypotension

Outcome

Myocardial injury after non-cardiac surgery (MINS), defined as serum Troponin T (TnT) ≥ 0.03 ng/mL within 30 days after surgerysurrogate

Intraoperative hypotension is independently and cumulatively associated with myocardial injury after major open abdominal surgery, with absolute MAP thresholds showing more consistent associations.

Main Result

Effect estimate: OR 3.81 (95% CI 2.20-6.61)

Limitations

Retrospective design with potential for residual confounding from unmeasured factors.
Did not investigate specific triggers of intraoperative hypotension such as acute hemorrhage.
Important perioperative management variables like vasoactive medication use, anesthetic depth, and fluid balance were not analyzed in detail.
Multiple comparisons across different hypotension thresholds increase the risk of type I error.
Single academic center study, which may affect generalizability.
Exclusion of a substantial proportion of initially screened patients may introduce selection bias.

Abstract

Background Myocardial injury after non-cardiac surgery (MINS) contributes to mortality after major open abdominal surgery. While intraoperative hypotension (IOH) is a proposed cause, its impact—defined using comprehensive thresholds—in this specific high-risk cohort remains underexplored. This study aimed to determine the association between the severity and duration of IOH and MINS. Methods We assessed patients undergoing open abdominal surgery with invasive blood pressure monitoring in a single-center retrospective cohort study conducted between June 2016 and July 2019. The primary exposure, IOH, was defined using three absolute and three relative thresholds of mean arterial pressure (MAP), according to established literature and clinical consensus. The primary outcome was MINS (serum Troponin T (TnT) ≥ 0.03 ng/mL within 30 days after surgery). A multivariable logistic regression analysis was applied to model the exposure–outcome relationship, adjusting for potential clinical confounders. Results Of the 8,281 patients screened, 1,461 met the inclusion criteria. MINS occurred in 175 patients (12.0%). MAP below three absolute thresholds (≤65, ≤60, and ≤55 mmHg) and three thresholds relative to the preinduction MAP (decreases of 30, 40, and 50% from baseline) were independently associated with MINS. For MAP ≤60 mmHg, the odds of MINS increased with longer durations of hypotension, rising from 1.54 (95% CI 0.98–2.44) for 1–5 min to 3.81 (95% CI 2.20–6.61) for ≥21 min. At the longest duration, lower MAP thresholds were associated with higher risk (OR 3.66 for ≤65 mmHg; 3.81 for ≤60 mmHg; and 8.42 for ≤55 mmHg). Similar associations were observed for relative MAP reductions. Conclusion In major open abdominal surgery patients, IOH, either based on absolute and relative thresholds, is independently and cumulatively associated with MINS. Associations based on absolute MAP thresholds appeared more consistent, whereas those based on relative reductions showed greater variability.

Ask AI

Helpful

Bookmark

View Full Paper