Blood Pressure Coefficient of Variation and Its Association With Cardiac Surgical Outcomes

BACKGROUND: Multiple studies completed in the ambulatory nonsurgical setting show a significant association between short- and long-term blood pressure variability and poor outcomes. However, perioperative blood pressure variability outcomes have not been well studied, especially in the cardiac surgical setting. In this study, we sought to assess whether systolic and mean arterial blood pressure variability were associated with 30-day mortality and in-hospital renal failure in patients undergoing cardiac surgery requiring cardiopulmonary bypass. Furthermore, blood pressure variability has not been evaluated specifically during each phase of surgery, namely in the pre-, intra- and postbypass phases; thus, we aimed also to assess whether outcomes were associated with phase-specific systolic and mean arterial blood pressure variability. METHODS: All patients undergoing cardiac surgery from January 2008 to June 2014 were enrolled in this retrospective, single-center study. Demographic, intraoperative, and postoperative outcome data were obtained from the institution's Society of Thoracic Surgery database and Anesthesia Information Management System. Systolic and mean arterial blood pressure variability were assessed using the coefficient of variation (CV). The primary outcomes were 30-day mortality and in-hospital renal failure in relation to the entire duration of a case, while the secondary outcomes assessed phase-specific surgical periods. In an effort to control the family-wise error rate, P values <.0125 were considered significant for the primary outcomes. results: of patients analyzed died within days surgery and experienced in-hospital renal failure. after adjusting covariates we found a statistically association between increasing cv systolic blood pressure mortality every increase in cvsbp there was odds death ratio confidence interval p .0001 experiencing failure with driven primarily by prebypass period because during phase .01 not postbypass .08 no mean arterial either or any including bypass phase. conclusions: variability associated development phase-specific relationships observed. further research is required to determine how prospectively detect elucidate opportunities intervention. accepted publication february funding: v. prasad supported us department defense national science engineering graduate fellowship. b. subramaniam institutes health project grant gm statistical writing support provided center anesthesia excellence at beth israel deaconess medical center. authors declare conflicts interest. reprints will be available from authors. address correspondence balachundhar md mph harvard school one rd c-650 boston ma e-mail bsubrama international society>

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