Relationship between intraoperative hypotension load and 7 d postoperative composite adverse outcomes in patients with ruptured abdominal aortic aneurysm

Zhou Xiaorui; Zhang Jinglan; Kou Lei; Xu Xuefeng; Chen Yao; Wang Sheng

doi:10.3760/j.issn.1673-4777.2026.02.005

Abstract：Objective To investigate the relationship between intraoperative hypotension load(HL)and 7 d postoperative composite adverse outcomes[MOFD-7,defined as the requirement for mechanical ventilation(invasive or non-invasive),hemodynamic support with vasoactive agents,or continuous renal replacement therapy on the 7th postoperative day,or death within 7 d after surgery]in patients undergoing open surgical repair(OSR)for ruptured abdominal aortic aneurysm(rAAA).Methods A retrospective analysis was conducted on 50 patients with rAAA who underwent OSR in Beijing Anzhen Hospital,Capital Medical University from August 2005 to November 2020.HL was defined as the cumulative area under the curve of mean arterial pressure(MAP)<65 mmHg(1 mmHg=0.133 kPa).Patients were divided into the non-MOFD-7 group(30 cases)and the MOFD-7 development group(20 cases)according to the occurrence of MOFD-7.Logistic regression analysis and receiver operating characteristic(ROC)curve were used to analyze the relationship between HL and MOFD-7,with MOFD-7 as the primary outcome.Results The incidence of MOFD-7 was 40.0％(20/50)among the 50 rAAA patients undergoing OSR,and the 30 d all-cause mortality was 10.0％(5/50),and all deaths occurred in the MOFD-7 development group.The proportion of preoperative hemorrhagic shock,preoperative serum creatinine and lactic acid levels in the MOFD-7 development group were significantly higher than those in the non-MOFD-7 group(all P<0.05).In terms of perioperative management,HL,norepinephrine equivalent,and the first postoperative lactic acid level in the MOFD-7 development group were significantly higher than those in the non-MOFD-7 group;intraoperative fluid infusion volume,intraoperative blood loss,and intraoperative blood transfusion volume(including intraoperative red blood cell transfusion volume and intraoperative plasma transfusion volume)in the MOFD-7 development group were significantly greater than those in the non-MOFD-7 group(all P<0.05).Multivariate Logistic regression analysis showed that after adjusting for age,gender,preoperative serum creatinine and preoperative lactic acid,HL(per 100 mmHg·min increase)was still independently associated with MOFD-7(odds ratio=1.298,95％confidence interval:1.034-1.630,P=0.025).The area under the curve of HL alone and the multivariate model for predicting MOFD-7 were 0.770 and 0.870,respectively.Restricted cubic spline analysis indicated an approximately monotonic increasing relationship between HL and the risk of MOFD-7;when HL exceeded approximately 75 mmHg·min,the risk of adverse outcomes increased significantly with further elevation of HL.Conclusion In patients undergoing OSR for rAAA,a higher intraoperative HL is associated with an increased risk of MOFD-7.Perioperative management should aim to minimize HL to improve early prognosis.