The Effect Of Intraoperative Hypotension On Postoperative Recovery In Elderly Patients After Gastrointestinal Surgery:A Prospective Observation Analysis

Part oneObjective This study aims to evaluate the early quality of recovery of elderly patients after gastrointestinal surgery with QoR-40,and investigate the effect of the related factors.Methods Written informed consent were obtained from all participants.Those patients,who older than 65 years,received surgery of gastrointestinal tumor resection in Nan Jing Drum Tower Hospital from February to June 2017,and were asked to answer QoR-40 questionnaires during the initial postoperative day(POD)1,2.Preoperative demographic characteristics including details of age,sex,BMI,hypertension,smoking status,and time of educated were recorded.Operative data including the type of anesthesia and surgery,length of operation,time of hypotension,blood and infusion volume were recorded.Postoperative information including length of stay and complications were recorded.Results Finally,142 patients’ data were analyzed.According to whether intraoperative hypotension occurred,all patients were divided into two groups.The results showed that intraoperative absolute or relative hypotension had no significant effect on early postoperative QoR-40 scores(P>0.05).Compared with TIVA,the type of intravenous-inhalation combined anesthesia increased the risk of intraoperative absolute hypotension(P<0.05).And this study demonstrates that the type of surgery,elderly age(≥70)are influencing factors for poor quality of recovery(P<0.05);However,the sex,ASA status and the type of anesthesia do not effect postoperative recovery.Conclusion The study well demonstrates that the occurrence of intraoperative absolute or relative hypotension has no significant effect;And surgery type and age are influencing factors for early postoperative recovery quality.However,more future study are needed to research the effect of intraoperative hypotension for postoperative recovery.The benefit of evaluating postoperative recovery quality used by QoR-40 is to provide reference for making clinical decision.Part twoObjective Explore factors affecting postoperative delirium in elderly patients after gastrointestinal surgery.Methods Patients who received surgery of gastrointestinal tumor resection in Nan Jing Drum Tower Hospital from February to June 2017 were included.During the initial postoperative day(POD)1,2,the CAM Chinese Revision was used to evaluate their mental state,and VAS was used to evaluate their postoperative pain.Preoperative demographic characteristics including details of age,sex,BMI,hypertension,smoking status,and time of educated were recorded.Operative data including the type of anesthesia and surgery,length of operation,time of hypotension,blood and infusion volume were recorded.Postoperative information including length of stay and complications were recorded.Results Among 142 patients,there were 13 patients occurred PD,and the rate is 9%in our study.According to whether PD occurred,all patients were divided into two groups.Results showed that baseline data between two groups were no statistically significant(P>0.05),and the difference of surgery type and postoperative pain between two groups was statistical significance(P<0.05),and there was no difference in the accumulative time of IOH(P>0.05).Analysis of potential risk factors with statistical or clinical significance were used multivariable logistic regression,and the results showed that postoperative pain in POD1 is risk factor for PD(OR 1.803,95%CI 1.274-2.553,P=0.001).Conclusion The rate of PD in our study is 9%.Intraoperative MAP decreasing over 20%of the preoperative basic blood pressure was defined as intraoperative hypotension.The results showed that there was no relationship between IOH and PD,and that postoperative pain in POD1 is risk factor for PD.So more study are needed to research the association between IOH and PD.Preoperative delirium assessment and perioperative analgesia should be performed to reduce the risk of PD.