Blood Pressure–Centered Strategies and Perioperative Outcomes

Intraoperative hypotension is very common, affecting 30% to 80% of surgical patients. Results of observational studies suggest that even brief episodes of intraoperative hypotension are associated with an increased risk of postoperative complications, but the definition of hypotension varies across studies. Prior observational studies suggest that exposure to a mean arterial pressure (MAP) lower than 60 mm Hg to 65 mm Hg increases the risk of postoperative myocardial and kidney injury. Based on these data, current guidelines recommend maintaining MAP at 60 mm Hg or higher during surgery. However, several questions remain unsettled: Is intraoperative hypotension is a marker of underlying illness or a modifiable contributor to harm? Does the optimal MAP target vary across individuals, suggesting that a more personalized approach is warranted?