Tailored Treatment for SBP Reduces Risk for Organ Dysfunction After Major Surgery

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Postoperative organ dysfunction by day 30 occurred in 46.3% and 63.4% of patients in the individualized treatment and standard treatment groups, respectively.
Postoperative organ dysfunction by day 30 occurred in 46.3% and 63.4% of patients in the individualized treatment and standard treatment groups, respectively.

HealthDay News — Management targeting an individualized systolic blood pressure (SBP) is associated with reduced risk of organ dysfunction among patients undergoing major surgery who are at increased risk of postoperative complications, according to a study published in the Journal of the American Medical Association.

Emmanuel Futier, MD, PhD, from the University Clermont Auvergne in Clermont-Ferrand, France, and colleagues randomized adult patients at increased risk of postoperative complications with a preoperative acute kidney injury risk index of class III or higher undergoing major surgery lasting 2 hours or longer under general anesthetic to an individualized management strategy aimed at achieving SBP within 10% of the reference value (147 patients) or to a standard management strategy (145 patients).

The primary outcome was a composite of systemic inflammation response syndrome and dysfunction of at least 1 of the renal, respiratory, cardiovascular, coagulation, and neurological organ systems by postoperative day 7.

The researchers found that the primary outcome event occurred in 38.1% and 51.7% of patients assigned to the individualized treatment group and standard treatment strategy group, respectively (relative risk, .73). Postoperative organ dysfunction by day 30 occurred in 46.3% and 63.4% of patients in the individualized treatment and standard treatment groups, respectively (adjusted hazard ratio, .66).

"Management targeting an individualized systolic blood pressure, compared with standard management, reduced the risk of postoperative organ dysfunction," the authors write.

Several authors disclosed financial ties to industry.

Reference

Futier E, Lefrant JY, Guinot PG, et al. Effect of individualized vs standard blood pressure management strategies on postoperative organ dysfunction among high-risk patients undergoing major surgery [published online September 27, 2017]. JAMA. doi: 10.1001/jama.2017.14172

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