Felix van Lier

Background: Hypotension is common during and after surgery and is known to be associated with myocardial injury. This study investigated whether hypotension in the recovery room after non-cardiac surgery is associated with myocardial injury. Methods: In this retrospective cohort study, data were used from a clinical registry of patients aged 60 years or older undergoing intermediate-to-high-risk non-cardiac surgery. Patients admitted to the Intensive Care Unit or the high-dependency ward were excluded. Hypotension was characterized by the time-weighted average (TWA) below 75 mmHg mean arterial pressure (MAP) measured in the recovery room after surgery. Patients were divided into quartiles of increasing hypotension exposure, i.e., increasing TWA. The primary outcome was myocardial injury, defined as peak high-sensitivity troponin T over 50 ng/L within the first 3 postoperative days. Results: In total, 2660 patients were analyzed. Hypotension in the recovery room was observed in 1119 (43.7%) of the patients while myocardial injury occurred in 198 (7.7%) patients. There was no association between increasing exposures of hypotension and myocardial injury (lowest TWA vs. highest TWA quartile: 7.9% vs. 9.0%, p = 0.65). Furthermore, there was no association between hypotension and 30-day mortality (highest vs. lowest quartile: 1.5% vs. 1.5%, p = 0.82). However, an association was noted at 1 year (9.8% vs. 14.7%, p = 0.02). Conclusions: Hypotension in the recovery room after moderate-to-high-risk non-cardiac surgery is not associated with the development of myocardial injury.

Background: Small studies have shown that patients with advanced coronary artery disease might benefit from a more liberal blood transfusion strategy. The goal of this pilot study was to test the feasibility of a blood transfusion intervention in a group of vascular surgery patients who have elevated cardiac troponins in rest.Methods: We conducted a single‐centre, randomised controlled pilot study. Patients with a preoperative elevated high‐sensitive troponin T undergoing non‐cardiac vascular surgery were randomised between a liberal transfusion regime (haemoglobin >10.4 g/dL) and a restrictive transfusion regime (haemoglobin 8.0–9.6 g/dL) during the first 3 days after surgery. The primary outcome was defined as a composite endpoint of all‐cause mortality, myocardial infarction or unscheduled coronary revascularization.Results: In total 499 patients were screened; 92 were included and 50 patients were randomised. Postoperative haemoglobin was different between the intervention and control group; 10.6 versus 9.8, 10.4 versus 9.4, 10.9 versus 9.4 g/dL on day one, two and three respectively (p < 0.05). The primary outcome occurred in four patients (16%) in the liberal transfusion group and in two patients (8%) in control group.Conclusion: This pilot study shows that the studied transfusion protocol was able to create a clinically significant difference in perioperative haemoglobin levels. Randomisation was possible in 10% of the screened patients. A large definitive trial should be possible to provide evidence whether a liberal transfusion strategy could decrease the incidence of postoperative myocardial infarction in high risk surgical patients.