Association of Intraoperative Hypotension and Hypertension on Hospital Stay, and in-Hospital Mortality after Major Elective and Emergency Surgery in the University Teaching Hospital of Kigali (CHUK)

Abstract

Background:Intraoperative blood pressure fluctuation is associated with poor outcomes in a recent study done in high-income countries; although exact values to cause harm are still not well identified. There is limited information in lower-income countries. Aims: To evaluate the association of intraoperative hypotension, and hypertension with prolonged hospital length of stay and in-hospital mortality after major elective and emergency surgery in the University Teaching hospital of Kigali (CHUK). Methods: This is a prospective observational study linking intraoperative hypotension and hypertension with postoperative in-hospital outcomes. I collected data from 350 patients that underwent elective and emergency major surgeries from 1st June to 31st August 2020; demographic, pre- and post-operative information were collected manually using a questionnaire, whereas intraoperative information was electronically extracted from photographed intraoperative anesthesia charts using optical recognition software. I linked intraoperative hypotension and hypertension with hospital length of stay and postoperative in-hospital mortality by the univariate analysis, negative binomial regression model, and a logistic regression model, using R software (version 4.0.3). Results: Three hundred and fifty patients (350) were included in the analysis. In the univariate analysis, older age, female gender, and more time spent below a diastolic blood pressure of 50 mmHg was found to be frequent inthe group of patients that died. In the logistic regression model, mortality had an association with an increased age (OR: 1.04, CI: 1.00, 1.09, p= 0.037) and more time spent below a diastolic blood pressure less than 50 mmHg (OR: 1.02, CI: 1.01, 1.04, p=0.004). I found no association with mortality for hypertension, gender, presence or absence of comorbidity, and emergency vs. elective surgery. Male gender, emergency surgery, orthopedic and plastic surgery had an association with increased hospital length of stay. ENT surgery had an association with a shorter length of stay. iv Conclusions: I found an association between intraoperative hypotension and post operative in-hospital mortality, and there was no association with intraoperative hypertension. The study indicates no association between hospital length of stay and intraoperative hypotension or hypertension, however, the hospital length of stay was increased in the male gender, emergency surgery, and orthopedic surgery. Further larger studies are needed in lower-income countries to evaluate their association for improving intraoperative blood pressure monitoring and management.