A new analysis of previous studies looked at whether customizing blood pressure management during major non-cardiac surgery helps patients. The analysis combined data from 4,017 adults, with about half receiving individualized blood pressure targets and the other half receiving conventional care.
The main goals were to see if individualized care reduced acute kidney injury or the need for kidney replacement therapy, and deaths from any cause. The analysis found no significant reduction in either. The risk of kidney injury or replacement therapy was 0.88 times that of conventional care, but this could have been due to chance. Similarly, the risk of death was 0.96 times, also not statistically significant.
However, there was a notable benefit: delirium was significantly less common with individualized care. The risk was 0.55 times that of conventional care, a statistically significant finding. Also, patients in the individualized group had a higher average blood pressure during surgery, by about 5.53 mmHg, which was also significant.
No differences were seen for heart attacks, cognitive problems, other complications, or length of hospital stay. Safety details were not reported.
This is a meta-analysis, which means it combines results from several studies, but the primary outcomes did not show clear benefits. The main takeaway is that individualized blood pressure management might help prevent delirium, but it does not appear to reduce kidney injury or death. Patients should discuss their blood pressure management with their surgical team.
