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Postoperative Hypotension and Surgical Site Infections After Colorectal Surgery

A Retrospective Cohort Study

Yilmaz, Huseyin O., MD*; Babazade, Rovnat, MD*; Leung, Steve, MD*; Zimmerman, Nicole M., MS*,†; Makarova, Natalya, MS*,†; Saasouh, Wael, MD*; Stocchi, Luca, MD; Gorgun, Emre, MD; Sessler, Daniel I., MD*; Turan, Alparslan, MD*

doi: 10.1213/ANE.0000000000003666
Perioperative Medicine: Original Clinical Research Report

BACKGROUND: Hypotension compromises local tissue perfusion, thereby reducing tissue oxygenation. Hypotension might thus be expected to promote infection. Hypotension on surgical wards, while usually less severe than intraoperative hypotension, is common and often prolonged. In this retrospective cohort study, we tested the hypotheses that there is an association between surgical site infections and low postoperative time-weighted average mean arterial pressure and/or postoperative minimum mean arterial pressure.

METHODS: We considered patients who had colorectal surgery lasting ≥1 hour at the Cleveland Clinic between 2009 and 2013. We defined blood pressure exposures as time-weighted average (primary) and minimum mean arterial pressure (secondary) within 72 hours after surgery. We assessed associations between continuous blood pressure exposures with a composite of deep and superficial surgical site infection using separate severity-weighted average relative effect generalized estimating equations models, each using an unstructured correlation structure and adjusting for potentially confounding variables.

RESULTS: A total of 5896 patients were eligible for analysis. Time-weighted mean arterial pressure and surgical site infection were not significantly associated, with an estimated odds ratio (95% CI) of 1.03 (0.99–1.08) for a 5-mm Hg decrease (P = .16). However, there was a significant inverse association between minimum postoperative mean arterial pressure and infection, with an estimated odds ratio of 1.08 (1.03–1.12) per 5-mm Hg decrease (P = .001).

CONCLUSIONS: Postoperative time-weighted mean arterial pressure was not associated with surgical site infection, but lowest postoperative mean arterial pressure was. Whether the relationship is causal remains to be determined.

From the Departments of *Outcomes Research, Anesthesiology Institute

Quantitative Health Sciences

Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio.

Published ahead of print July 27, 2018.

Accepted for publication June 12, 2018.

Huseyin O. Yilmaz, MD, is currently affiliated with the Department of Critical Care, Turkish Ministry of Health, Health Sciences University, Dr Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital, Izmir, Turkey.

Rovnat Babazade, MD, is currently affiliated with the Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas.

Wael Saasouh, MD, is currently affiliated with the Department of Anesthesiology, Detroit Medical Center, Detroit, Michigan.

Funding: Institutional and/or departmental.

The authors declare no conflicts of interest.

Reprints will not be available from the authors.

Address correspondence to Alparslan Turan, MD, Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Ave, P-77, Cleveland, OH 44195. Address e-mail to

© 2018 International Anesthesia Research Society
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