Although deviations in intraoperative blood pressure are assumed to be associated with postoperative mortality, critical blood pressure thresholds remain undefined. Therefore, the authors estimated ...the intraoperative thresholds of systolic blood pressure (SBP), mean blood pressure (MAP), and diastolic blood pressure (DBP) associated with increased risk-adjusted 30-day mortality.
This retrospective cohort study combined intraoperative blood pressure data from six Veterans Affairs medical centers with 30-day outcomes to determine the risk-adjusted associations between intraoperative blood pressure and 30-day mortality. Deviations in blood pressure were assessed using three methods: (1) population thresholds (individual patient sum of area under threshold AUT or area over threshold 2 SDs from the mean of the population intraoperative blood pressure values), (2). absolute thresholds, and (3) percent change from baseline blood pressure.
Thirty-day mortality was associated with (1) population threshold: systolic AUT (odds ratio, 3.3; 95% CI, 2.2 to 4.8), mean AUT (2.8; 1.9 to 4.3), and diastolic AUT (2.4; 1.6 to 3.8). Approximate conversions of AUT into its separate components of pressure and time were SBP < 67 mmHg for more than 8.2 min, MAP < 49 mmHg for more than 3.9 min, DBP < 33 mmHg for more than 4.4 min. (2) Absolute threshold: SBP < 70 mmHg for more than or equal to 5 min (odds ratio, 2.9; 95% CI, 1.7 to 4.9), MAP < 49 mmHg for more than or equal to 5 min (2.4; 1.3 to 4.6), and DBP < 30 mmHg for more than or equal to 5 min (3.2; 1.8 to 5.5). (3) Percent change: MAP decreases to more than 50% from baseline for more than or equal to 5 min (2.7; 1.5 to 5.0). Intraoperative hypertension was not associated with 30-day mortality with any of these techniques.
Intraoperative hypotension, but not hypertension, is associated with increased 30-day operative mortality.
The Veterans Health Administration (VHA) within the Department of Veterans Affairs (VA) was interested in determining how mobile tablets may be perceived by clinicians for use in clinical settings. ...Therefore, we conducted an evaluation to assess how performance might differ between two devices and to gather feedback on device use. We conducted a within-subject comparison with 32 clinicians involving a usability test and two questionnaires. Qualitative data was organized around eight themes: facilitators and barriers to tablet use, observations of physical use, device specific advantages and disadvantages, and the Patient Viewer mobile application. Clinicians envisioned many facilitators to tablet use, but also voiced some concerns. Participants rated one device significantly better than the other for questionnaire items related to ‘Access and Efficiency’, ‘Introduction into the Clinical Environment’, ‘Usability and Usefulness’, and ‘Desire to Use’. Results can be used by mobile health app developers, healthcare organizations considering device purchases, and researchers conducting studies on tablets to inform respective work.
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