SYSTEMATIC REVIEW article
Front. Cardiovasc. Med.
Sec. Intensive Care Cardiovascular Medicine
Preoperative Patient Risk Factors for Intraoperative Hypotension: A Systematic Review and Meta-Analysis
Provisionally accepted
Nils Daum
Daniel BillMoritz ThieleJulian FelberDario Von Wedel
Claudia Spies
Felix BalzerRudolf Moergeli
Oliver Hunsicker
Anika MüllerDennis ContagAnne PohrtAnnika Bald
Max Kayser
Sascha Treskatsch
Maximilian Markus*- Charité University Medicine Berlin, Berlin, Germany
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Background Intraoperative hypotension (IOH) presents a risk factor for postoperative organ dysfunction. However, as a unique definition of IOH is still missing, the influence of individual preoperative patient characteristics on IOH remains poorly understood. This systematic review aimed to examine the variability in IOH definitions and to identify preoperative risk factors associated with IOH. Methods A systematic literature search was conducted from inception to March 2, 2024. Studies reporting on IOH and from which the association between preoperative characteristics and IOH in cardiac and non-cardiac surgery could be derived were included. Odds ratios (ORs) were either extracted directly or calculated based on available patient-level data. Pooled estimates were generated using a random-effects model. Results Out of 7,361 screened studies, 78 met the inclusion criteria. Heterogeneity was high due to varying IOH definitions. 14 preoperative factors were included in the meta-analysis. Older age (OR 1.03, 95%CI 1.02–1.04) and female sex (OR 1.16, 95%CI 1.08–1.24) were associated with increased IOH risk. ASA-II was linked to lower risk compared to ASA-III (OR 0.80, 95%CI 0.70–0.91). Diabetes mellitus (OR 1.18, 95%CI 1.04–1.35) and arterial hypertension (OR 1.56, 95%CI 1.33–1.83) were independent predictors. ACE inhibitor use (angiotensin-converting enzyme inhibitor use; OR 1.63, 95%CI 1.42–1.88), angiotensin receptor blocker (ARB) use (OR 1.38, 95%CI 1.01–1.89), and emergent surgery (OR 1.25, 95%CI 1.09–1.42) also increased IOH incidence. The risk of bias was low to moderate. Conclusion The substantial variability in IOH definitions and several preoperative IOH influencing patient characteristics highlight the need for standardized criteria to improve comparability and guide personalized perioperative management.
Keywords: Intraoperative hypotension, Preoperative risk factors, Patient characteristics, Perioperative management, cardiovascular risk, Meta-analysis
Received: 19 Sep 2025; Accepted: 20 Nov 2025.
Copyright: © 2025 Daum, Bill, Thiele, Felber, Von Wedel, Spies, Balzer, Moergeli, Hunsicker, Müller, Contag, Pohrt, Bald, Kayser, Treskatsch and Markus. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Maximilian Markus, maximilian.markus@charite.de
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