ORIGINAL RESEARCH article
Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
Relationship of Intraoperative Hypotension with Major Adverse Cardiovascular Events and Acute Kidney Injury after pancreaticoduodenectomy
Provisionally accepted
- Nanjing Medical University, Nanjing, China
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Background: Intraoperative hypotension (IOH) is a common concern during major surgery and is associated with end-organ injury. However, its specific impact on major adverse cardiovascular events (MACE) and acute kidney injury (AKI) following pancreaticoduodenectomy (PD)has not been well elucidated. Methods: A retrospective cohort study was conducted, including 1846 patients who underwent PD between January 2018 and December 2023. Intraoperative mean arterial pressure (MAP) was recorded continuously via radial arterial catheterization. Restricted cubic spline models (RCS) were used to assess the associations of IOH with MACE and AKI. IOH was quantified using four exposure metrics: absolute maximum decrease (AMD), time under threshold (TIME), area under the threshold (AUT), and time-weighted average (TWA) to further analyse the association of MACE and AKI risk at the stratified threshold of MAP<60, 65, 70 mmHg. Results: Among 1846 patients enrolled, 211(11.4%) developed MACE and 52(2.8%) developed postoperative AKI. Multivariable-adjusted RCS analysis revealed that AKI occurrence increased progressively with decreasing MAP, whereas MACE followed a J-shaped curve with the turn-point of MAP around 65 mmHg. Forest plot analysis found that AMD was the sole metric that maintained a statistically significant association with both MACE and AKI across all tested MAP thresholds (<70, 65, 60 mmHg). Regarding specific thresholds, AMD, AUT, and TWA were significantly associated with MACE at MAP <65 mmHg, whereas AMD, TIME, AUT, and TWA all demonstrated statistical significance for AKI at MAP <60 mmHg. Conclusion: IOH is associated with MACE and AKI following PD. The higher MAP threshold for MACE (<65 mmHg) than for AKI (<60 mmHg) suggests the need for stricter hemodynamic goals to safeguard organs with differing ischemic thresholds.
Keywords: Acute Kidney Injury, adverse postoperative outcomes, Intraoperative hypotension, Major adverse cardiovascular events, Pancreaticoduodenectomy
Received: 25 Nov 2025; Accepted: 10 Feb 2026.
Copyright: © 2026 fan, yanfei, mengli, jingjiang, xuechun, liuyan, rongting, xingjun and Youli. 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: Hu Youli
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