The effect of structured proctoring and hypotension prediction index teaching on incidence and duration of intraoperative hypotension in patients undergoing major abdominal surgery: A comparative study of two monitoring systems.

Abstract

Introduction: Intraoperative hypotension (IOH) is a commonly observed phenomenon during major abdominal surgery. The severity and duration of IOH have been identified as crucial factors in the development of these complications.

Methods: The study compares two groups of adult patients undergoing major abdominal surgery: one group received standard hemodynamic management using the Edwards Flotrac device, while the second group received hypotension prediction index duration, and severity of intraoperative hypotension in high-risk patients (HPI)-guided hemodynamic management, with anesthesiologists trained via a structured proctoring program. We retrospective analized prospectively gathered anonymized data from 6 Spanish centers during 2021-2022. The primary outcome measure was the time-weighted average of mean arterial pressure < 65 mmHg (MAP) during surgery (TWA MAP 65 mmHg). The secondary outcome measures included incidence of hypotensive episodes, total time with hypotension, and percentage of time spent in hypotension during surgery.

Results: A total of 607 patients were analyzed, 270 in the pre-proctoring group vs 337 in the post-proctoring group. The median TWA MAP 65 mmHg was 0.09 mm Hg (interquartile range (IQR), 0.00-0.31 mm Hg) post-proctoring group vs 0.37 mmHg (IQR, 0.08-1.01 mm Hg) in the pre-proctoring group, for a median difference of 0.19 mmHg (95% CI, 0.13-0.27 mmHg; P < .001), whereas the median TWA MAP < 55 mmHg was 0.00 mmHg (IQR, 0.00-0.01 mmHg) post-proctoring group vs 0.00 mmHg (IQR, 0.00-0.07 mm Hg) in the pre-proctoring group, 0 mmHg (95% CI, 0.0-0.02 mm Hg; P < .001).

Conclusions: A structured program in hemodynamic training based on the intraoperative use of the hemodynamic prediction index decreases the incidence.