- Design
- Bayesian random-effects meta-analysis of randomised trials
- Population
- 15 trials of major noncardiac surgery
- Primary outcome
- All-cause mortality
- Effect
- OR 1.00 (95% CI 0.83–1.21); AKI OR 0.87 (0.73–1.03); myocardial injury OR 1.04 (0.93–1.15)
A Bayesian meta-analysis pooled 15 randomised trials of protocolised intraoperative arterial pressure targeting in major noncardiac surgery, compared with usual care or lower targets.
Mortality was unchanged (OR 1.00, 95% CI 0.83–1.21), as was myocardial injury after noncardiac surgery (OR 1.04). Acute kidney injury had the most favourable estimate (OR 0.87, 95% CI 0.73–1.03), but it crossed no effect, heterogeneity was moderate and the result shifted when single trials were removed.
This does not license hypotension. Usual care in these trials already avoided profound or prolonged low pressure. What it suggests is that rigid, protocolised targets above that add little, and that kidney benefit, if any, may depend on the wider haemodynamic picture — flow, fluids and vasopressor choice.
- Keep avoiding sustained intraoperative hypotension as part of routine care.
- Do not expect a rigid higher pressure protocol to reduce mortality or myocardial injury.
- Consider individual baseline pressure, particularly in patients with chronic hypertension.
- Watch the kidney signal; it is uncertain rather than absent.
Why it matters
It tempers the push for strict numerical pressure protocols in every major case.
Don't overread it
The kidney estimate is fragile and sensitive to single trials.
The statistics, in plain English
A credible interval of 0.73 to 1.38 for mortality means the data fit anything from a modest benefit to a modest harm. The prediction interval (0.56–1.78) is wider still, showing how much trials differed.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for anaesthesiology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free