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dc.contributor.authorAckland, GLen_US
dc.contributor.authorAbbott, TEFen_US
dc.contributor.authorPearse, RMen_US
dc.contributor.authorKarmali, SNen_US
dc.contributor.authorWhittle, Jen_US
dc.contributor.authorMinto, Gen_US
dc.contributor.authorPOM-HR Study Investigatorsen_US
dc.date.accessioned2017-07-21T15:18:43Z
dc.date.available2017-03-07en_US
dc.date.issued2018-01en_US
dc.date.submitted2017-05-22T12:57:00.392Z
dc.identifier.urihttp://qmro.qmul.ac.uk/xmlui/handle/123456789/24953
dc.description.abstractBACKGROUND: Systemic arterial pulse pressure (systolic minus diastolic pressure) ≤53 mm Hg in patients with cardiac failure is correlated with reduced stroke volume and is independently associated with accelerated morbidity and mortality. Given that deconditioned surgical and heart failure patients share similar cardiopulmonary physiology, we examined whether lower pulse pressure is associated with excess morbidity after major surgery. METHODS: This was a prospective observational cohort study of patients deemed by their preoperative assessors to be at higher risk of postoperative morbidity. Preoperative pulse pressure was calculated before cardiopulmonary exercise testing. The primary outcome was any morbidity (PostOperative Morbidity Survey) occurring within 5 days of surgery, stratified by pulse pressure threshold ≤53 mm Hg. The relationship between pulse pressure, postoperative morbidity, and oxygen pulse (a robust surrogate for left ventricular stroke volume) was examined using logistic regression analysis (accounting for age, sex, BMI, cardiometabolic co-morbidity, and operation type). RESULTS: The primary outcome occurred in 578/660 (87.6%) patients, but postoperative morbidity was more common in 243/ 660 patients with preoperative pulse pressure ≤53 mm Hg{odds ratio (OR): 2.24 [95% confidence interval (CI): 1.29-3.38]; P<0.001). Pulse pressure ≤53 mm Hg [OR:1.23 (95% CI: 1.03-1.46); P=0.02] and type of surgery were independently associated with all-cause postoperative morbidity (multivariate analysis). Oxygen pulse <90% of population-predicted normal values was associated with pulse pressure ≤ 53 mm Hg [OR: 1.93 (95% CI: 1.32-2.84); P=0.007]. CONCLUSIONS: In deconditioned surgical patients, lower preoperative systemic arterial pulse pressure is associated with excess morbidity. These data are strikingly similar to meta-analyses identifying low pulse pressure as an independent risk factor for adverse outcomes in cardiac failure. Low preoperative pulse pressure is a readily available measure, indicating that detailed physiological assessment may be warranted. CLINICAL TRIAL REGISTRATION: ISRCT registry, ISRCTN88456378.en_US
dc.description.sponsorshipNIAA/RCoA Basic Science Career Development award (GLA).en_US
dc.format.extent94 - 100en_US
dc.languageengen_US
dc.language.isoenen_US
dc.relation.ispartofBr J Anaesthen_US
dc.rightsThis is a pre-copyedited, author-produced version of an article accepted for publication in British Journal of Anaesthesia following peer review.
dc.subjectblood pressureen_US
dc.subjectcardiovascularen_US
dc.subjectmorbidityen_US
dc.subjectAgeden_US
dc.subjectBlood Pressureen_US
dc.subjectCohort Studiesen_US
dc.subjectComorbidityen_US
dc.subjectEchocardiographyen_US
dc.subjectExercise Testen_US
dc.subjectFemaleen_US
dc.subjectHumansen_US
dc.subjectMaleen_US
dc.subjectMiddle Ageden_US
dc.subjectOxygenen_US
dc.subjectPerioperative Careen_US
dc.subjectPostoperative Complicationsen_US
dc.subjectProspective Studiesen_US
dc.subjectRisk Factorsen_US
dc.subjectSurgical Procedures, Operativeen_US
dc.subjectVentricular Function, Leften_US
dc.titleArterial pulse pressure and postoperative morbidity in high-risk surgical patients.en_US
dc.typeArticle
dc.rights.holder© 2017 Oxford University Press (OUP)
dc.identifier.doi10.1016/j.bja.2017.11.009en_US
pubs.author-urlhttps://www.ncbi.nlm.nih.gov/pubmed/29397143en_US
pubs.issue1en_US
pubs.notes12 monthsen_US
pubs.publication-statusPublisheden_US
pubs.volume120en_US
dcterms.dateAccepted2017-05-22en_US
qmul.funderParasympathetic modulation of perioperative myocardial injury.::Royal College Of Anaesthetists/ British Journal of Anaesthesiaen_US
qmul.funderParasympathetic modulation of perioperative myocardial injury.::Royal College Of Anaesthetists/ British Journal of Anaesthesiaen_US
qmul.funderParasympathetic modulation of perioperative myocardial injury.::Royal College Of Anaesthetists/ British Journal of Anaesthesiaen_US


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