Concurrence of intraoperative hypotension, low minimum alveolar concentration, and low bispectral index is associated with postoperative death

Mark D. Willingham, Elliott Karren, Amy M. Shanks, Michael F. O'Connor, Eric Jacobsohn, Sachin Kheterpal, Michael S. Avidan

Research output: Contribution to journalArticlepeer-review

67 Scopus citations

Abstract

Background: An intraoperative concurrence of mean arterial pressure less than 75 mmHg, minimum alveolar concentration less than 0.8, and bispectral index less than 45 has been termed a triple low state. An association between triple low and postoperative mortality has been reported but was not replicated in a subsequent study. The authors pooled existing data from clinical trials to further evaluate the purported association in an observational study. Methods: This retrospective observational study included 13,198 patients from three clinical trials: B-Unaware, BAGRECALL, and Michigan Awareness Control Study. Patients with greater than 15 not necessarily consecutive minutes of triple low were propensity matched to controls with similar characteristics and comorbidities. A multivariable Cox proportional hazards model was used to evaluate the association between triple low duration and postoperative mortality. Results: Thirty-day mortality was 0.8% overall, 1.9% in the triple low cohort, and 0.4% in the nontriple low cohort (odds ratio, 5.16; 95% CI, 4.21 to 6.34). After matching and adjusting for comorbidities, cumulative duration of triple low was significantly associated with an increased risk of mortality at 30 days (hazard ratio, 1.09; 95% CI, 1.07 to 1.11, per 15 min) and 90 days (hazard ratio, 1.09; 95% CI, 1.08 to 1.11, per 15 min). Conclusion: There is a weak independent association between the triple low state and postoperative mortality, and the propensity- matched analysis does not suggest that this is an epiphenomenon.

Original languageEnglish
Pages (from-to)775-785
Number of pages11
JournalAnesthesiology
Volume123
Issue number4
DOIs
StatePublished - Oct 1 2015

Fingerprint

Dive into the research topics of 'Concurrence of intraoperative hypotension, low minimum alveolar concentration, and low bispectral index is associated with postoperative death'. Together they form a unique fingerprint.

Cite this