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Baroreflex impairment and morbidity after major surgery

Toner, A; Jenkins, N; Ackland, GL; (2017) Baroreflex impairment and morbidity after major surgery. British Journal of Anaesthesia , 117 (3) pp. 324-331. 10.1093/bja/aew257. Green open access

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Abstract

Background Baroreflex dysfunction is a common feature of established cardiometabolic diseases that are most frequently associated with the development of critical illness. Laboratory models show that baroreflex dysfunction impairs cardiac contractility and cardiovascular performance, thereby increasing the risk of morbidity after trauma and sepsis. We hypothesized that baroreflex dysfunction contributes to excess postoperative morbidity after major surgery as a consequence of the inability to achieve adequate perioperative tissue oxygen delivery. Methods In a randomized controlled trial of goal-directed haemodynamic therapy (GDT) in higher-risk surgical patients, baroreflex function was assessed using the spontaneous baroreflex sensitivity (BRS) method via an arterial line placed before surgery, using a validated sequence method technique (one beat lag). The BRS was calculated during the 6 h postoperative GDT intervention. Analyses of BRS were done by investigators blinded to clinical outcomes. The primary outcome was the association between postoperative baroreflex dysfunction (BRS <6 mm Hg s−1, a negative prognostic threshold in cardiovascular pathology) and early postoperative morbidity. The relationship between baroreflex dysfunction and postoperative attainment of preoperative indexed oxygen delivery was also assessed. Results Patients with postoperative baroreflex dysfunction were more likely to sustain infectious {relative risk (RR) 1.75 [95% confidence interval (CI): 1.07–2.85], P=0.02} and cardiovascular morbidity [RR 2.39 (95% CI: 1.22–4.71), P=0.008]. Prolonged hospital stay was more likely in patients with baroreflex dysfunction [unadjusted hazard ratio 1.62 (95% CI: 1.14–2.32), log-rank P=0.004]. Postoperative O2 delivery was 36% (95% CI: 7–65) lower in patients with baroreflex dysfunction in those not randomly assigned to GDT (P=0.02). Conclusions Baroreflex dysfunction is associated with excess morbidity, impaired cardiovascular performance, and delayed hospital discharge, suggesting a mechanistic role for autonomic dysfunction in determining perioperative outcome.

Type: Article
Title: Baroreflex impairment and morbidity after major surgery
Open access status: An open access version is available from UCL Discovery
DOI: 10.1093/bja/aew257
Publisher version: https://doi.org/10.1093/bja/aew257
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Science & Technology, Life Sciences & Biomedicine, Anesthesiology, autonomic nervous system, baroreflex, postoperative complications, ORGAN DYSFUNCTION SYNDROME, ACUTE MYOCARDIAL-INFARCTION, AUTONOMIC DYSFUNCTION, CARDIOVASCULAR MORTALITY, ANTIINFLAMMATORY PATHWAY, POSTOPERATIVE MORBIDITY, ORTHOPEDIC-SURGERY, NONCARDIAC SURGERY, RATE-VARIABILITY, HEART-FAILURE
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Experimental and Translational Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci > Department of Targeted Intervention
URI: https://discovery.ucl.ac.uk/id/eprint/10053419
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