Perioperative blood pressure management
Blood pressure (BP) management is a core part of enhanced postoperative care. We have summarised 33 recent studies on low blood pressure, BP targets, vasopressors, monitoring and outcome measures.
Each summary links to the original paper.
Why hypotension matters · 6 articles
What the evidence says about low blood pressure around surgery and its links to kidney injury, heart complications and death.
Article summaries
Low blood pressure, norepinephrine dose and kidney injury
Saugel et al. · Br J Anaesth
Retrospective cohort of 38,338 adults having non-cardiac surgery, testing whether intraoperative hypotension and cumulative norepinephrine dose are each independently associated with postoperative AKI. The exposures were area under MAP 65 mm Hg and total intraoperative norepinephrine; the comparison was patients developing AKI versus not, within 7 days. Both hypotension burden (OR 1.55 per mm Hg·day) and norepinephrine dose (OR 1.02 per µg/kg) were independently associated with AKI. The authors conclude it is prudent to avoid both profound hypotension and high vasopressor doses. A 2026 rebuttal (Schnider/Sleigh) cautions the dose–AKI link may reflect the drug-titration paradox — confounding by illness severity.
Read the paper (opens in a new tab) →Peripheral perfusion index and kidney injury after surgery (VEGA-1)
Krone et al. · Br J Anaesth
Exploratory post-hoc analysis of the pragmatic, cluster-randomised VEGA-1 trial in 2,534 major non-cardiac surgery patients receiving continuous vasopressor infusions. The exposure was peripheral perfusion index (a photoplethysmographic marker of tissue perfusion); the comparison was higher versus lower perfusion-index burden. The primary outcome was postoperative AKI (8.9% incidence); 30-day mortality was secondary. Larger areas and longer cumulative times below perfusion-index thresholds, and a lower time-weighted-average perfusion index, were associated with AKI (strongest for area under 1%: adjusted OR 1.32) and with 30-day mortality (adjusted OR 0.68). The findings suggest perfusion, not just pressure, signals renal risk, but the analysis is observational and hypothesis-generating.
Read the paper (opens in a new tab) →Heart complications after surgery and 30-day mortality
STARSurg/EuroSurg Collaborative · Anaesthesia
International prospective cohort (446 hospitals, 28 European countries) of 24,203 adults having major abdominal surgery, designed to define the incidence, timing and mortality impact of postoperative cardiovascular complications (StEP-COMPAC definitions). There was no intervention; the comparison was patients with versus without cardiovascular complications. Complications occurred in 611 patients (2.5%); 458 (1.9%) died within 30 days, 26.9% of deaths cardiac-related. Mortality was far higher with cardiovascular complications (19.8% vs 1.4%), persisting after risk adjustment (hazard ratio 4.15). The authors estimate preventing all such complications would reduce mortality by roughly 21% (relative). It frames cardiovascular complications as common, early and prognostically important, but cannot establish causation.
Read the paper (opens in a new tab) →Fluids, vasopressors and kidney injury after major abdominal surgery
Chiu et al. · Br J Anaesth
Retrospective multicentre analysis of major abdominal surgeries in adults across 26 US hospitals (2015–2019; Multicenter Perioperative Outcomes Group database). They examined intraoperative crystalloid volume and vasopressor (norepinephrine-equivalent) exposure to the primary outcome, postoperative acute kidney injury (AKI; KDIGO creatinine criteria). Over the period clinicians gave progressively less fluid and more vasopressor and, despite shorter hypotension duration, AKI incidence rose. From predictive models, increasing crystalloid from 1 to 10 ml/kg/h was associated with a 58% lower AKI risk and an increase in vasopressor use from 0 to 0.04 μg/kg/min of norepinephrine equivalents had 1.8-fold increased risk of AKI. The authors conclude that treating hypotension with liberal vasopressors at the expense of fluid is associated with more AKI, though causation cannot be inferred.
Read the paper (opens in a new tab) →Blood pressure medicines before surgery and BP during surgery
Gurunathan et al. · Anesth Analg
Prospective cohort of 537 adults undergoing ambulatory surgery, examining whether preoperative renin–angiotensin system blockade predisposes to early intraoperative hypotension. Patients were grouped by exposure: no antihypertensives, ACEI/ARB taken <10 h before surgery, ACEI/ARB ≥10 h before, or other antihypertensives. The primary outcome was early hypotension (first 15 min after induction; systolic fall >30% or MAP <55 mm Hg). Early hypotension occurred in 25% overall and was more frequent with ACEI/ARB intake (30–41%) than with no antihypertensives (21%; P=0.02); any hypotension was also commoner on antihypertensives. The study supports timing/withholding considerations for ACEI/ARBs, though it is observational and confined to day-surgery.
Read the paper (opens in a new tab) →Is low blood pressure after surgery a target we can change?
Vail et al. · Br J Anaesth
Editorial accompanying the SQUEEZE study, arguing that postoperative hypotension, less studied than its intraoperative counterpart yet potentially more consequential, is a complex but modifiable target. It summarises SQUEEZE (>25,000 patients, 42 countries), in which postoperative vasopressor-infusion use averaged 3.9% but varied widely between countries and was associated with higher complications, longer stays and higher in-hospital mortality. The authors caution that vasopressor use is a marker of, not necessarily a remedy for, clinically significant hypotension, and that current treatment paradigms lack an evidence base. They call for standardised definitions and randomised trials. As an editorial, it offers perspective rather than new data.
Read the paper (opens in a new tab) →Summaries prepared by the ARRC team, Royal Adelaide Hospital. Last reviewed [DATE].
Setting BP targets · 4 articles
Recent trials testing whether higher, lower or personalised blood pressure targets change outcomes for patients.
Key takeaways
- Two large 2025 trials (PRETREAT and IMPROVE-multi) found that higher or personalised BP targets during surgery did not improve outcomes.
- A review of 28 trials found lower BP targets were not harmful and may slightly lower mortality, mostly in intensive care.
- The key open question: is low blood pressure a cause of harm, or a sign of how unwell the patient already is?
Article summaries
Do personalised BP targets improve outcomes after major abdominal surgery?
Saugel et al. · JAMA · IMPROVE-multi trial
Randomised, single-blind trial at 15 German university hospitals in 1,142 patients (≥45 years) undergoing elective major abdominal surgery (≥90 min) with at least one additional high-risk criterion. Patients received individualised MAP targets based on preoperative mean night-time blood pressure versus routine management (MAP ≥65 mm Hg). The primary outcome was a 7-day composite of AKI, myocardial injury, non-fatal cardiac arrest or death. It occurred in 33.5% (individualised) versus 30.5% (routine) (relative risk 1.10, 95% CI 0.93–1.30; P=0.31), with none of 22 secondary outcomes differing. Individualised, higher MAP targeting did not improve outcomes — arguably the most rigorous test of personalised perioperative BP targeting to date.
Read the paper (opens in a new tab) →Treating low blood pressure early versus as needed
Kant et al. · JAMA · PRETREAT trial
Randomised trial at two Dutch tertiary hospitals comparing proactive, risk-stratified intraoperative MAP targets (low-risk ≥70, intermediate ≥80, high-risk ≥90 mm Hg) against usual care (generally avoiding MAP <65) in adults having elective non-cardiac surgery. The primary outcome was functional disability at 6 months (WHODAS 2.0). The trial was stopped early for futility after 3,247 of 5,000 planned patients. Mean WHODAS scores were essentially identical (17.7 proactive vs 18.2 usual care; difference −0.5, 95% credible interval −1.9 to 0.9), with no difference across 23 secondary outcomes. Proactively targeting higher pressures did not improve patient-centred recovery, though usual care already avoided severe hypotension.
Read the paper (opens in a new tab) →Lower versus higher blood pressure targets: a review of 28 trials
D’Amico et al. · Crit Care Med
Systematic review and meta-analysis of 28 RCTs (15,672 patients; 12 critical-care, 16 perioperative) comparing lower versus higher blood-pressure targets, with all-cause mortality at longest follow-up as the primary outcome. Pooled across 23 mortality-reporting trials, the lower-target groups had significantly lower mortality (13.3% vs 14.4%; relative risk 0.93, 95% CI 0.87–0.99; I²=0%), plus less atrial fibrillation and fewer transfusions. Effects were driven mainly by ICU studies and treatment lasting >24 h, though sensitivity analyses were consistent. The authors conclude lower targets may be beneficial and that the long-assumed “higher is better” does not hold, supporting “protective haemodynamics”, while acknowledging residual uncertainty.
Read the paper (opens in a new tab) →The limits of strategies built around blood pressure
Legrand et al. · JAMA
JAMA editorial accompanying the IMPROVE-multi and PRETREAT trials, reflecting on their concordant negative results. It notes both trials successfully reduced intraoperative hypotension (e.g. fewer MAP<65 episodes) yet neither improved postoperative outcomes or disability. The authors argue this challenges the entrenched “higher-is-better” assumption derived from observational data, and raises the central unresolved question: is intraoperative hypotension a modifiable cause of harm, or merely a marker of underlying illness? They highlight the limits of blood-pressure–centred strategies, pressure being a surrogate for organ perfusion, and call for re-examination of targets and more personalised, perfusion-oriented approaches. As an editorial, it interprets rather than generates evidence.
Read the paper (opens in a new tab) →Summaries prepared by the ARRC team, Royal Adelaide Hospital. Last reviewed [DATE].
Vasopressors and fluids · 9 articles
How we treat low blood pressure: choosing and timing vasopressors, their safety, and the balance with fluid therapy.
Article summaries
Starting norepinephrine early in major abdominal surgery
Trocheris-Fumery et al. · Anesthesiology
Single-centre randomised trial (Amiens) in 473 analysed patients (>50 years, ASA ≥II) having major abdominal surgery, testing prophylactic continuous norepinephrine from induction versus reactive ephedrine boluses for hypotension. The primary outcome was any 30-day complication (Clavien–Dindo ≥1). Intraoperative hypotension was far less frequent with norepinephrine (15% vs 74%), and complications were lower (44% vs 58%; relative risk 0.58, 95% CI 0.40–0.83), with fewer pulmonary complications. The authors conclude prophylactic norepinephrine may reduce postoperative complications. A key caveat: the design changed both the drug and the mode of delivery (continuous prophylaxis vs reactive bolus), so it cannot isolate which factor drove benefit; single-centre.
Read the paper (opens in a new tab) →Side effects of vasopressors given through a peripheral IV line
Zhang et al. · JAMA Netw Open
Systematic review and meta-analysis of 49 studies (33,060 catheters) quantifying adverse events from peripheral intravenous (PIV) vasopressor administration in adults with hypotension, shock or critical illness, and the proportion avoiding central venous catheter (CVC) placement. Pooled minor adverse events were low (~2.3% overall; 2.6% norepinephrine, 2.9% phenylephrine), and major events rare (venous thromboembolism only in midline-catheter studies); CVC placement was avoided in ~60%. The authors conclude that, with appropriate monitoring, short-term PIV vasopressor delivery is reasonably safe and can reduce the need for central access. Source studies were largely observational with variable definitions, but the safety signal is reassuring for early peripheral treatment.
Read the paper (opens in a new tab) →Goal-directed haemodynamic therapy: do results depend on trial size?
Müller, Sessler & Saugel · Br J Anaesth
Systematic review and meta-analysis (correspondence) of intraoperative goal-directed haemodynamic therapy (GDHT), stratifying 89 eligible RCTs by sample size to probe small-study bias. For pneumonia and surgical-site infection, benefits were apparent in small trials (e.g. pneumonia OR ~0.61 in trials of 0–100 patients) but attenuated or absent in larger trials, mirroring the largest trial, OPTIMISE II (~2,500 patients), which found no reduction in infectious complications. The authors conclude GDHT’s reported benefit is inversely related to trial size (the “winner’s curse”/publication bias), cautioning clinicians that small trials routinely overstate effects. The analysis re-examines existing data rather than generating new clinical outcomes.
Read the paper (opens in a new tab) →Vasopressors for low blood pressure after surgery
Douglas et al. · Br J Anaesth
Prospectively registered systematic review of vasopressor use for postoperative hypotension after adult non-cardiac, non-obstetric surgery, screening 3,201 articles and including 24 studies (7 RCTs, 17 cohorts; 13,866 patients). No meta-analysis was possible owing to heterogeneity. Only one study was high quality, two moderate and 21 low; 16 relied on clinical assessment alone to guide treatment. A median 42% of patients received vasopressors (norepinephrine most common), with vasodilation the most-cited presumed mechanism, yet only three studies linked hypotension to a vasodilatory cause. The review concludes the evidence base for treating postoperative hypotension with vasopressors is weak and calls for mechanism-focused research.
Read the paper (opens in a new tab) →Ephedrine versus phenylephrine and kidney injury
Oh et al. · J Clin Anesth
Single-centre retrospective cohort of 45,144 adults having elective non-cardiac surgery (2011–2024), comparing intraoperative bolus ephedrine versus phenylephrine for treating hypotension. The primary outcome was AKI within 7 days. Most patients received ephedrine (90.5%); overall AKI incidence was 3.9%. After multivariable adjustment, phenylephrine was associated with higher AKI odds than ephedrine (OR 1.27, 95% CI 1.09–1.47; P=0.002), with a non-linear dose–response ceiling effect. The authors suggest vasopressor choice may be a modifiable factor for renal outcomes. As a single-centre observational study, residual confounding (e.g. why phenylephrine was chosen) limits causal inference, but it raises a practical agent-selection question.
Read the paper (opens in a new tab) →How often vasopressors are used after surgery worldwide (SQUEEZE)
Jammer et al. · Br J Anaesth
International prospective cohort (228 hospitals, 42 countries; 2020–2023) quantifying postoperative vasopressor-infusion use after non-cardiac surgery and its associated outcomes. Among 25,675 participants, 3.9% (Cohort A) received postoperative vasopressor infusions, but use ranged 0–18% across hospitals (median odds ratio 2.30), variation unexplained by case-mix or procedure. Vasopressor infusion was associated with higher in-hospital mortality (15.5%), more organ failure and longer stays. The authors conclude postoperative vasopressor practice is highly variable and associated with worse outcomes, and that current treatment paradigms lack evidence, an impetus for interventional trials. Being observational, it cannot establish whether vasopressors cause harm or simply mark sicker patients.
Read the paper (opens in a new tab) →Vasoactive drugs and mortality in cardiogenic shock
Ortega-Hernández et al. · Front Cardiovasc Med
Single-centre observational study of patients with acute myocardial infarction–related cardiogenic shock monitored with pulmonary artery catheters, examining whether greater vasoactive use, even when haemodynamic goals were met, predicts mortality. Patients were grouped by number of vasoactive drugs (0–1, 2, >2). End-organ function deteriorated progressively with escalating vasoactive use, and the >2-drug group had markedly higher in-hospital mortality (hazard ratio 4.62). The authors conclude higher vasoactive requirement is independently associated with death in this population. Included as a cross-domain analogue, it reinforces the recurring signal that vasopressor/inotrope intensity may track illness severity and harm though, being observational, causality is unresolved.
Read the paper (opens in a new tab) →Fluid therapy in non-cardiac surgery
Eichlseder & Saugel · Ann Intensive Care
Narrative review of intraoperative fluid therapy in adults having non-cardiac surgery, covering fluid type, volume and administration strategy. It notes balanced crystalloids better match physiological electrolytes, though moderate volumes of 0.9% saline appear not to increase complications; moderate hydroxyethyl-starch volumes seem safe intraoperatively despite ICU concerns; and human albumin lacks outcome trials justifying its cost. The authors recommend a mildly positive intraoperative fluid balance for major surgery and advise that fluid responsiveness should inform, but not solely dictate, fluid administration. They emphasise wide practice variation, with the attending anaesthetist the main determinant of volume given. As a non-systematic review, it synthesises rather than tests evidence.
Read the paper (opens in a new tab) →The drug-titration paradox
Schnider, Minto & Sleigh · Br J Anaesth
Correspondence critiquing Saugel and colleagues’ finding that cumulative norepinephrine dose is independently associated with postoperative AKI. The authors invoke the “drug-titration paradox”: because norepinephrine is titrated to blood pressure, sicker patients with refractory hypotension receive more drug, so dose may be a surrogate for severity rather than a cause of injury. They argue standard multivariable regression cannot disentangle this feedback loop (cyclical causality between dose, MAP and AKI), and suggest individual-patient dose–MAP curves and structural-equation/causal modelling instead. They conclude the “independent risk factor” interpretation may be premature. This is a methodological commentary, not new empirical data, but an important causal caution.
Read the paper (opens in a new tab) →Summaries prepared by the ARRC team, Royal Adelaide Hospital. Last reviewed [DATE].
Monitoring and prediction · 9 articles
Tools that track or predict low blood pressure, including the Hypotension Prediction Index (HPI), and what they add.
Article summaries
Delaying arterial lines in patients with shock (EVERDAC)
Muller et al. · N Engl J Med
Multicentre, open-label, non-inferiority RCT in 1,010 ICU patients with shock within 24 hours of admission, comparing non-invasive monitoring (automated brachial cuff) with early (<4 h) arterial-catheter insertion (non-inferiority margin 5 percentage points). Only 14.7% of the non-invasive group ultimately needed an arterial line, versus 98.2% of the invasive group. The primary outcome, 28-day all-cause mortality, was 34.3% versus 36.9% (adjusted risk difference −3.2 points; P=0.006 for non-inferiority), with similar per-protocol results. The authors conclude deferring arterial catheterisation is non-inferior, supporting non-invasive monitoring as a default in ICU shock and reserving arterial lines for selected patients. This is an ICU (not intraoperative) trial.
Read the paper (opens in a new tab) →How well the Hypotension Prediction Index performs
Davies et al. · Perioper Med
Observational performance study evaluating how reliably Hypotension Prediction Index (HPI) alerts precede haemodynamic-instability events in surgical patients, across both invasive arterial-line and non-invasive finger-cuff datasets. The analysis measured the proportion of HPI alerts followed within 15 minutes by an instability event at alert thresholds of 50 and 85. In the arterial-line dataset, 94.6% (threshold 85) and 91.4% (threshold 50) of alerts were followed by instability; in the finger-cuff dataset, 96.2% and 94.1%. The authors conclude HPI predicts impending instability with high accuracy, while explicitly noting that whether HPI-guided treatment improves patient outcomes remains unproven. Industry co-authorship and a process (not outcome) endpoint are limitations.
Read the paper (opens in a new tab) →Continuous predictive monitoring and hospital costs
Carreon et al. · Spine
Retrospective, propensity-matched secondary analysis (41 patients per group) of adults having elective multilevel posterior thoracolumbar fusion, comparing predictive hemodynamic monitoring (PHM; HPI-based) against no PHM. PHM patients had shorter intraoperative hypotension (6.6 vs 13.3 min) and hypertension durations, similar fluid/transfusion volumes, fewer complications per patient (borderline, P=0.053) and significantly shorter length of stay (4.5 vs 7.0 days), implying ~$2,500 potential savings per case. The authors conclude PHM reduces intraoperative haemodynamic instability with possible cost and length-of-stay benefits. The primary study was Edwards-funded, the sample is small and single-centre, and the endpoint is economic rather than a hard clinical outcome.
Read the paper (opens in a new tab) →Using deep learning to identify types of hypotension
Jian et al. · Br J Anaesth
Study using unsupervised deep learning to identify and validate physiological endotypes of hypotension in surgical and critically ill patients. In the development dataset the model identified four endotypes, vasodilation, hypovolaemia, myocardial depression and bradycardia, reproduced in two independent validation datasets (surgical and critically ill). The algorithm assigns each hypotensive data point a probability for each endotype, potentially enabling mechanism-specific treatment rather than uniform vasopressor escalation. The authors conclude endotyping could guide individualised management. The work is industry-affiliated (Edwards) and at the model-development stage, not yet linked to clinical outcomes, but it offers a conceptual bridge between monitoring and cause-directed treatment.
Read the paper (opens in a new tab) →HPI is no better than a simple MAP threshold
Mulder et al. · Anesthesiology
Prospective observational study in 100 patients having moderate-to-high-risk elective non-cardiac surgery, comparing the HPI alarm (>85) with simple MAP-threshold alarms for predicting intraoperative hypotension within 5–15 minutes. A MAP threshold of 73 mm Hg agreed with the default HPI alarm 97% of the time, and a 72 mm Hg threshold gave the most comparable predictive performance. Areas under the ROC curve were near-identical for HPI (0.89) and concurrent MAP (0.88), both outperforming extrapolated or delta MAP. The authors conclude the machine-learning index could be replaced by a MAP-based alarm set at 72–73 mm Hg, and that future studies must benchmark against MAP and outcomes.
Read the paper (opens in a new tab) →Two ways to validate HPI, and why the results differ
Davies et al. · Anesthesiology
Methodological study (2,022 patients; ~4.15 million 20-second measurements) re-analysing HPI’s predictive accuracy using both the original case-control “backward” design and a cohort “forward” design, to test whether the backward approach inflated performance. For predicting MAP <65 mm Hg, the area under the curve was modestly higher by backward than forward analysis at 5 minutes (0.957 vs 0.923) but nearly identical at 10–15 minutes; no variable other than MAP achieved an AUC >0.7. The authors conclude HPI’s predictive utility remains high under updated methodology, similar to the original. The finding both tempers and partly rebuts the selection-bias critique, while underscoring MAP’s dominant contribution.
Read the paper (opens in a new tab) →HPI versus current and projected MAP
[AUTHORS] · Anesthesiology
Research letter (secondary analysis) directly comparing HPI software, current MAP, and linearly extrapolated MAP for predicting intraoperative hypotension (MAP <65 mm Hg), using a case-control method in patients having surgery >90 min with invasive monitoring. Predictive ability was assessed 5, 10 and 15 minutes ahead. The authors found no clinically significant difference between HPI and single MAP values, while linearly extrapolated MAP performed significantly worse than both. They conclude a simple MAP value predicts hypotension as well as the proprietary index, so extrapolation adds little. The letter reinforces the argument that HPI may not outperform basic blood-pressure monitoring.
Read the paper (opens in a new tab) →HPI accuracy may be overstated by selection bias
Enevoldsen & Vistisen · Anesthesiology
Special article arguing that the Hypotension Prediction Index’s reported accuracy is inflated by selection bias. Because the algorithm’s original training/validation selected data such that a MAP <75 mm Hg essentially always predicts hypotension, and current MAP is itself a strong predictor of imminent hypotension, the authors contend the data-selection process systematically overestimated both current MAP’s and the index’s predictive performance. They suggest other HPI validation studies share this flaw and that further independent validation, and possibly model updates, are needed. This is a methodological/statistical critique rather than a clinical study, but it underpins the wider debate about whether HPI adds value beyond MAP alone.
Read the paper (opens in a new tab) →Shedding light on the HPI “black box”
Vistisen et al. · Anesthesiology
Editorial accompanying two HPI methodology studies, aiming to clarify the statistical and analytic issues surrounding this proprietary “black box” index. It reviews the debate over whether HPI — built from 23 arterial-waveform features — genuinely predicts hypotension (MAP <65 mm Hg) better than MAP itself, and addresses confusion in terminology adapted from classical epidemiology. The authors note that, although the two accompanying studies differ in some respects, both concur the index does not appear to provide additional predictive value beyond MAP. They call for transparent algorithm development, standardised methodology and outcome-focused evaluation. As an editorial, it contextualises the evidence rather than adding primary data.
Read the paper (opens in a new tab) →Summaries prepared by the ARRC team, Royal Adelaide Hospital. Last reviewed [DATE].
Measuring outcomes · 5 articles
How we define and measure meaningful recovery, including days alive and out of hospital (DAOH).
Article summaries
Days alive and out of hospital after emergency laparotomy
Spurling, Moonesinghe & Oliver · Br J Anaesth
Retrospective cohort validating days alive and out of hospital (DAOH) after emergency laparotomy, linking prospectively collected English data (2013–2017; 78,921 records) to national admission and mortality records over one postoperative year. The study assessed construct validity (DAOH variation with known risk factors) and predictive validity for one-year mortality, and the optimal observation window. Median DAOH was 16 days at 30 days and 75 at 90 days; DAOH was shorter with risk factors, and shorter DAOH30 predicted higher one-year mortality. The authors conclude DAOH is a valid patient-centred outcome for emergency laparotomy, best measured at 30 days, recommending its use in trials and quality improvement.
Read the paper (opens in a new tab) →Days alive and out of hospital as a patient-centred outcome
Jerath, Moonesinghe et al. · Anesthesiology
Validation study of days alive and out of hospital (DAOH) as a patient-centred perioperative outcome, analysing 540,072 adults undergoing one of 12 major elective non-cardiac procedures (2006–2014). DAOH at 30 days (primary), 90 and 180 days was related to patient, surgical and hospital characteristics, and “poor” DAOH30 (below the tenth percentile) to in-hospital complications and longer-term poor DAOH. DAOH varied sensibly with surgical complexity, complications and risk factors, and predicted longer-term outcomes. The authors conclude DAOH is a feasible, valid, patient-centred endpoint suitable for future trials. The work provides a standardised outcome measure to address the heterogeneity that hampers perioperative haemodynamic research.
Read the paper (opens in a new tab) →Expert consensus on haemodynamic instability around surgery
Scott et al. · Anesth Analg
Consensus recommendations from the Anesthesia Patient Safety Foundation’s 2022 Conference on perioperative haemodynamic instability. Following expert presentations and a modified Delphi process, the group produced 17 high-level recommendations across seven domains: current knowledge, preventing instability-related harm across all care phases, data-driven quality improvement, informing patients, the importance of technology, a national campaign, and advancing the science. The document tabulates organ harm by lowest MAP and duration and references POISE-3. It aims to translate unsettled evidence into pragmatic best practice for identifying and managing at-risk patients. Being expert consensus where trial evidence is lacking, it codifies opinion and best judgment rather than definitive proof.
Read the paper (opens in a new tab) →Standard definitions for patient-centred outcomes (StEP-COMPAC)
Moonesinghe et al. · Br J Anaesth
Systematic review plus three-round Delphi consensus from the Standardised Endpoints in Perioperative Medicine (StEP-COMPAC) initiative, defining recommended patient-centred outcome measures for perioperative trials. From a literature review yielding numerous patient-satisfaction, quality-of-life, well-being, functional-status and life-impact measures, the group (Delphi response rates 87–100%) shortlisted recommended instruments. The authors conclude several patient-centred measures are suitable for future studies and recommend every clinical study include at least one within its endpoint suite. This consensus work directly addresses the inconsistent outcome reporting that undermines pooling across blood-pressure, vasopressor and monitoring studies, providing the standardisation foundation for better-designed perioperative trials. It is a consensus document, not an empirical study.
Read the paper (opens in a new tab) →Why new care pathways need formal evaluation
Moonesinghe · Br J Anaesth
Editorial arguing that healthcare innovations, from robotic surgery to new care pathways, must undergo formal, rigorous evaluation before widespread adoption, not be assumed effective. Using surgical safety checklists as an example (an impressive original before-and-after study followed by less convincing wider-implementation results), it illustrates the “second translational gap” between efficacy in trials and effectiveness at scale, and notes that not all innovations are reproducibly beneficial. The piece is a methodological/philosophical plea directly relevant to perioperative haemodynamic technologies (individualised targets, HPI, goal-directed therapy): benefit in one setting does not guarantee benefit when deployed broadly. It offers argument and perspective rather than primary data.
Read the paper (opens in a new tab) →Summaries prepared by the ARRC team, Royal Adelaide Hospital. Last reviewed [DATE].