Preoperative Pulse Pressure and Adverse Postoperative Outcomes: A Meta-Analysis

Abstract

Objective: To evaluate the association between preoperative pulse pressure (PP) and the incidences of renal, neurologic, cardiac, and mortality outcomes after surgery.

Design: Systematic review and meta-analysis of cohort studies.

Setting: Hospitals.

Participants: Patients who underwent cardiac or noncardiac surgeries.

Intervention: The preoperative PP was measured.

Measurement and main results: Relevant cohort studies were obtained by systematic search of PubMed and Embase databases. A randomized effect model was used to pool the results. The multivariate adjusted risk ratio (RR) and its 95% confidence intervals (CI) were calculated to reflect the association between preoperative PP and adverse postoperative outcomes. Twelve cohort studies that included 40,143 patients who had undergone cardiac, vascular, or noncardiac surgery were included in the meta-analysis. The results showed that above a threshold of 40 mmHg, an increase in preoperative PP of 10 mmHg was independently associated with increased risk for renal events (adjusted RR: 1.13, 95% CI 1.08-1.19, p < 0.001; I² = 0%), neurologic events (adjusted RR: 1.75, 95% CI 1.01-3.02, p = 0.04; I² = 70%), cardiac events (adjusted RR: 1.19, 95% CI 1.03-1.37, p = 0.01; I² = 0%), major cardiovascular adverse events (adjusted RR: 1.62, 95% CI 1.10-2.41, p = 0.02; I² = 0%), and overall mortality (adjusted RR: 1.13, 95% CI 1.07-1.20, p < 0.001; I² = 0%) after surgery.

Conclusions: Patients with higher-than-normal preoperative PP are at increased risk for adverse postoperative outcomes.

Keywords: mortality; pulse pressure; renal dysfunction; stroke; surgery.