Intraoperative hypotension is associated with shortened overall survival after lung cancer surgery

Abstract Background: Intraoperative hypotension is associated with worse perioperative outcomes, but evidence is lacking regarding long-term survival after cancer surgery. Herein, we analyzed the association between intraoperative blood pressure fluctuation and overall survival after lung cancer surgery. Methods: In this retrospective cohort study, 676 patients who received lung cancer surgery between January 1, 2006 and December 31, 2009 were reviewed. Intraoperative hyper- and hypotension were defined according to their correlation with long-term survival. The primary endpoint was overall survival. The association between intraoperative blood pressure fluctuation and overall survival was analyzed with multivariable Cox proportional hazard models. Results: Long-term follow-ups were completed in 515 patients with a median duration of 5.2 years. The estimated 5-year survival rates were 66.5%, 61.3%, 56.5%, and 41.2% in patients with only hypertension (systolic blood pressure >140 mmHg for ³5 minutes), with both hyper- and hypotension (systolic blood pressure <100 mmHg for ³5 minutes), with neither hyper- nor hypotension, and with only hypotension during surgery, respectively. After adjusting confounding factors, intraoperative hypotension was significantly associated with shortened overall survival (compared with patients with only intraoperative hypertension, those with both hyper- and hypotension: hazard ratio [HR]1.033, 95% confidence interval [CI] 0.709 to 1.507, p=0.864; those with neither hyper- nor hypotension: HR 0.952, 95% CI 0.608 to 1.489, p=0.829; those with only hypotension: HR 1.736, 95% CI 1.218 to 2.475, p=0.002). Conclusions: For patients undergoing lung cancer surgery, intraoperative hypotension, but not hypertension, was associated with shortened overall survival.