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Hypotension-Avoidance Versus Hypertension-Avoidance Strategies in Noncardiac Surgery
Maura Marcucci, Thomas Painter, David Conen, В. В. Ломиворотов, Daniel I. Sessler, Kate Leslie, Emmanuelle Duceppe, María José Martínez‐Zapata, Chew Yin Wang, Denis Xavier, Sandra Ofori, Michael Ke Wang, Sergey Efremov, Giovanni Landoni, Ydo V. Kleinlugtenbelt, Wojciech Szczeklik, Denis Schmartz, Amit X. Garg, Timothy G. Short, Mária Wittmann, Christian S. Meyhoff, Mohammed Amir, David Torres, Ameen Patel, Kurt Ruetzler, Joel L. Parlow, Vikas Tandon, Edith Fleischmann, André Lamy, Raja Jayaram, Sergey V. Astrakov, William Ka Kei Wu, Chao Chia Cheong, Sabry Ayad, М. Yu. Кirov, Miriam de Nadal, В. В. Лихванцев, Pilar Paniagua, Kamal Maheshwari, Richard Whitlock, Michael McGillion, Jessica Vincent, Ingrid Copland, Kumar Balasubramanian, Bruce Biccard, Sadeesh Srinathan, Samandar Ismoilov, Shirley Pettit, David Stillo, Andrea Kurz, Emilie P. Belley‐Côté, Jessica Spence, William F. McIntyre, Shrikant I. Bangdiwala, Gordon Guyatt, Salim Yusuf, P.J. Devereaux, Toby Richards, John W. Eikelboom, Chaoran Wu, Peter L Gross, Pavel S Roshanov, Ian Roberts, Dean Fergusson, Pierre Foëx, Finlay A. McAlister, Sara Di Diodato, Rosemary Howe, Hannah Bruce Macdonald, Louise Mastrangelo, Clare McGall, N Mercuri, Sarah Molnar, Trisha Southall, Jennifer Swanson, Makayla Tosh, Eric Deng, Tamara Marsden, Mark Molec, Olga Shestakovska, Robin Zhao, M. Yа. Yadgarov, D. Borisov, John G. Gorman, Teresa Cafaro, Stefano Italiano, Andrés Valenzuela Suárez, Steffen Blum, Nuria Ruiz-López, Christian E. Haarmark Nielsen, Anna Włudarczyk, Federico Germini, Javiera Paz Vasquez, L.J. Bleijerveen, Stefan Schandelmaier, Jesse Popov, Daniél V. Møller, Carlos Moliner Abós, Denis Losik, Arnav Agarwal, Chantal Mulkens, Е. Н. Фишер, Paweł Wrona, Martin Šrámek, Steffan Frosi Stella, Antonia Nucera, Franziska Kuestermann, Emmanuel E. Egom, Shaan Gupta, Luis E. Morillo, Alexander Thiel, Gillian Ormond, Louise de Prinse, Sam Lumb, S. Macklin, Christine S. Osborn, Johanna Somfleth, Carolyn M. Wood, David Highton, Palvannan Sivalingam, Allison Kearney, Sabrina Oishi, Victoria Forrester, Edward Pilling, Sibi Mathew-Kurian, Joanne Cummins, Juanita Muller, Surbhi Malhotra, Lucy Glazov, D. J. Wright, Michael H Bennett, Priscilla Marneros, Steve Cai, Natalie Pfund, Michael J. Challis, David Alcock, Robyn A. Seale, David Bramley, Joshua Szental, Justin Yeung, Miriam Towns, Kerry Gill, Samantha Bates, Sarah R. Bowman, Amos Moody, Paul Slocomb, Peter Smedley, James Marckwald, Ross Kerridge, Paul J. Healey, J. Douglas, Bernard D. Frost, Libia E. Machado Muñoz, Sue Chew, Andrea Barton, Amy Skiller, Sarah Boschen, Richard Bulach, Tina Maggio, Lauren Bulfin, Philip J. Peyton, Justin Nazareth, S. Baulch, Saskia Harris, Gayle Claxton, Bernhard Riedel, Kimberley Coleman, Jason P. Koerber, Adam Badenoch, Susan M Rattigan, Vanessa J. Scotland, Helen Vlachtsis, Tomás Corcoran, Andrew J. Toner, Nigel Dunk, Ned Douglas, Amit Surah, Vi Ha, Alfred Tanaka Mahumani, Jennifer R. Cope, Elenore Clark-MacKay, Barbara Kabon, Christian Reiterer, Alexander Taschner, Nikolas Adamowitsch, Oliver Zotti, Seyed Javad Bidgoli, Christiane Dzechi, C. Van Lerberghe, Hélène Besse, Ida Stany, Mona Momeni, Audrey Dieu, Ricardo Reinaldo Bergo, Frederico Dall’Orto, Gislayne R. Ribeiro, Keyla C. Bitencourt, Luciana Paula Cadore Stefani, Rosângela da Rosa Minuzzi, André P. Schmidt, Debora Roberta Dornelles, M Brandao, Kelly Lawrence, Philip Joseph, Patrick Magloire, Amna Ahmed, Conor Cox, Krysten Gregus, Baha Alazzoni, Jacquie Hare, Dale Williams, Dan Tushinski, Samir Raza, Shariq Haider, Amitabha Chakroborty, Shervin Zandi, Ahraaz Wyne, Jessica Huynh, Amanda Huynh, Tomas VanHelder, Susan G. O'Ĺeary, John Harlock, Mohamed Panju, Kajenny Srivaratharajan, Betty Chui, Ryan Proc, Lisa Trombetta, T Rapanos, Harsha Shanthanna, John Neary, Katie Connolly, Muammar Abdulrahman, Spencer Wikkerink, Faraaz Quraishi, Rahima Nenshi, Deborah DuMerton, Jason Erb, Jessica Shelley, Elorm Vowotor, Maria Karizhenskaia, Emile Peponoulas, Nikola Joly, François Martin Carrier, Roberta Daila Carling, Éva Amzallag, Catherine Lapointe, Diane Baptiste, Mélodie Fanay Boko, Luc Massicotte, Maxime Thibault, Brigitte Migneault, François Plante, François Girard, Juan C. Guzmán, Michael J. Jacka, Michelle M. Graham, James G. Greene, Derek Dillane, David L. Bigam, Ella McMurtry, Michael Zaugg, Jason Foerster, David A. Williams, Kelly B. Zarnke, Linet Kiplagat, Shannon M. Ruzycki, Evan Minty, Prism Schneider, Biniam Kidane, Duane J. Funk, Lawrence Tan, Richard Liu, Gordon Buduhan, Stephanie Enns, Emma Poole, Stuart A. McCluskey, Nour Ayach, Jo Carroll, Marcin Wąsowicz, Matteo Parotto, George Djaiani, Humara Poonawala, Marko Mrkobrada, George K. Dresser, Jaclyn A. Ernst, George Nicolaou, Luc Dubois, Audra A. Duncan, Karen L. Broadhurst, Brogan M. Johnston, Stephanie N. Handsor, Michael Prystajecky, Peter Hedlin, Amrita Sharma, Shrijal Bhavsar, Jennifer McMullen, Marco Lefebvre, Peter Ramon Moliner, L. Lanthier, Maite Fuentes, Valentina Paz, Alejandra Cares, Alejandra Díaz, Natalia Gordo-Herrera, Tiare de la Puente, Waldo Merino, Rubén Carrasco-Moyano, Claudio Carcamo, Gavin M. Joynt, Tony Gin, Lin Zhang, Gordon Choi, Wai‐Tat Wong, Linda M.L. Lai, Chi‐Fai Ng, Philip Wai Yan Chiu, James Y. Lau, Malcolm J. Underwood, Beaker Fung, Eva Lee, Ka Yan Hui, Winnie Wing Sam Chan, Sihua Qi, Yuying Xie, Mengdi Zhang, Xiaofen Liu, Ye Zhang, Rui Li Liu, Marlene Søgaard, Ossian Gundel, Viktor Bay Moseholm, Diana B. Jensen, M K Hansen, Anne Sofie Jensen, Sanne Dahl Thorsager Olesen, Naomi Nadler, Mette Krogh Østerby, Mojgan Vazin Kjeldsen, Jawad Ahmad Zahid, Nessn Azawi, Ismail Gögenür, Eske Kvanner Aasvang, Niels Brandt Højlund-Hansen, Theis S. Bak, Thomas Kistorp, Martin Andreas Røder, Pascal Alfonsi, Julia Lavergne, Sarah Makoudi, Hélène Beaussier, Richard K. Ellerkmann, Nicholas Kiefer, Holger Pohl, Anne Houben, Mihiri U. Amarasekara, Anke Hoffmann, Oliver Höhn, Giovanna Lurati Buse, Sebastian Roth, Alexandra Stroda, Ragnar Huhn-Wientgen, Johnnes Nienhaus, René M ́Pembele, Antony Adelowo, Mark Coburn, Claudia Neumann, Markus Velten, Alma Puscarevic, Gregor Massoth, Rolf Rossaint, Ana Kowark, Sebastian Ziemann, Linda Grüßer, Julia Wallqvist, Pascal Kowark, Christian Bach, Mangala Rao, Freeda Xavier, Susan Maria Subbin, Keyur Bhatt, Dhaval Mangukiya, Jignesh Patel, Kachhadiya Daxa, Sanjay Thumar, Viral Parekh, B. Vishwanath, D.N.B. Sachin, V. Shyam Gopal, D.M. Shivaraj, Singh Ajay, T. Veena, Ravinder Singh Sidhu, Gursaran Kaur Sidhu, Naveen Laiker, Abhitej Sidhu, K Varghese Zachariah, Anil Kumar, V S, Chakravarthy Jacob Joel, Priya Pushpavathi, Vishnuvardhana G.V., Nithya Manayath, Ravi Patil, Niranjan Mallanaik, Suresh B. Patankar, Suparn K. Khaladkar, Gururaj A. Padsalgi, Prashant V Rahate, Shantanu P. Sengupta, Rajasi Sengupta, S Uikey, Kunda Mungulmare, Shashikant L. Sahare, Prem Haridas Menon, Rajeev Damodaran Nair Sarojini Amma, Alen Sigamani, Manesh Stephen, Mohammed Ashraf, Navneet Kumar Chaudhry, Valsamma Abraham, Rajneesh Calton, Vipul Gurjar, Honeypal Maharau, Rahul Guhabiswas, Sanjay Dhiraaj, Surendra Kumar Agarwal, Puneet Goyal, Rajneesh Kumar Singh, Sabaretnam Mayilvagnan, Anil Agarwal, Anand Prakash, Stefano Turi, Nora Di Tomasso, G D'alessandro, Cristina Nakhnoukh, Carola Galbiati, Francesco Giuseppe Nisi, Gabriele Valsecchi, Rosalba Lembo, Francesco De Donato, Gaetano Lombardi, Barbara Ferrara, G. Oriani, T. Guerrerio, Cesare Donarini, Marisa Iacurti, Georges Ghanem, Claudia Brusasco, Giulia Orefice, Francesco Corradi, Michela Gandini, Michela De Rosa, Silvia Di Maio, Barbara Spanio Capra, Leila Mameli, Victoria Bosio, Giuseppe De Blasio, Luigi Zagra, Paolo Perazzo, Chiara Colombo, Federica Marra, Tyng Yan Ng, Nur Azreen Hussain, Ri Qi Yeow, Yang Qun Choy, Xue Lin Chan, Yuen Sin Lai, C. Gan, Ka Ting Ng, Nor Ashikin Md Sari, Boon Koon Yoong, Wen Bin Lim, Natasha Mohd Noh, Su Sian Lim, Edwin Sze Sian Yit, Tsyr Xiang Teoh, Shu Ching Teo, Samuel Ern Hung Tsan, Yong Peng Lim, Soon Keong Khaw, Tze Ling Ng, Camilla J. Ngen, Abigail D.R. ak Dennis Gimang, Hran Cisca H.Y. Sim, Choo Pei Jap, Kee Chai Sia, Sze Li Siow, S Cheah, Su Yin Loo, Yeh Han Poh, Yoke Yin Woo, Siti Hawa Tahir, Meng-Li Lee, Im Im Chin, Teik Hooi Khoo, Lean Wah Luah, Chow Yen Yong, Azelia Mansor, Hoong Hoong Ng, Joey J.Y. Soon, M Hamid, Hema Malini Manogharan, Siti Sufia Mohd Saleh, Teh Wahida Tusirin, Sabreena Ismail, Boon Tiang Lau, Soon Keat Shio, Chun Fai Chiang, Joyce Tien, Ellie Landman, Stefan J. Gelderman, Jan-Hein M.G. Cobben, Bas Staffhorst, Roel Mes, Hannie Elskamp-Meijerman, Monique Voskamp-Wierik te, Rochel Dijkgraaf, Kim M. Welberg, Judith J. Postmus, Silke J. Wagenvoort, Felix van Lier, René van Bruchem, Frank Grüne, Elizabeth A. Maxwell, Doug Campbell, Davina McAllister, V.K. SINGH, Leanda Ritchie, Sarah Dandy, Nicole Vogts, Andrew Wilson, Julius Dale-Gandar, Jane Denman, Nicholas Lightfoot, Sue Olliff, Helen Houston, Reuben Breadnam, Sioux Masters, Jonathan Termaat, Gay Mans, Kate Goldstone, Glenda Mouton, Tehreem Zahid, Sumeyya Azam, Ahmed Sohail, Yumna Hassan, Sibgha Aimon, Muhammad Uneeb, Maaz Ahmed Yusufi, Zia Nazir, Sundus Ayub Awan, Mohsin Nazir, Madeeha Rasheed, Haris Sheikh, Azhar Rehman, Amir Hafeez Shariff, Zia Ur Rehman, Anila Anjum, Maciej Chwała, Jacek Górka, Dorota Studzińska, Marcin Jelinek, Gabriela Domaszewicz, Weronika Wajda, Paweł Grudzień, Anna Mirek, Bartosz Kudliński, Jarosław Zawisza, Ilona Kauf, Magdalena Wirtek, Damian Grochulski, Alexey Y. Kulikov, Mikhail Alexeev, Konstantin S. Trukhin, Andrey A. Cherednichenko, И. А. Андрианова, Svetlana S. Mikhailova, А. А. Сорокин, Elizaveta A. Leonova, Timur A. Dzhumatov, Oleg V. Kuleshov, Alexander A. Safronov, Svetlana L. Nepomnyaschaya, Anna S. Kotova, Maxim S. Stoliarov, Д. В. Шматов, Nikita S. Kubin, Nazym A. Kalieva, Dmitry Shkarupa, Elena A. Shirshova, Elena Neporada, Konstantin N. Kungurtsev, Vyacheslav V. Zhukov, Ilya G. Werner, Igor Yu. Chudnovets, А. А. Карпенко, Gallina A. Zeidlits, M. N. Deryagin, Pavel E. Vedernikov, Liudmila V. Lomivorotova, A. M. Cherniavskiy, Г. Б. Мороз, Roman Osinsky, Marat Abubakirov, V. V. Kuzkov, Ayyaz Hussain, Darja V. Carionova, Yana Y. Ilyina, D. Volkov, М. М. Соколова, Maria V. Veshnyakova, Evgenia B. Lochekhina, А. М. Овезов, Levan Berikashvili, Oleg N. Gerasimenko, N. V. Ermokhina, E.V. Ryabova, В. В. Субботин, Artem N. Kusovlev, Kristina Kadantseva, A. A. Klimov, Svetlana Tsiryatyeva, Kobus Bergh, Estie Cloete, Ettienne Coetzee, Margot Flint, M Nejthardt, Jan H.R. Becker, Sophie Mathijs, Bernd G. Lenhard, Leanne K. Frankish, A.E González Font, Rubén Sierra Díaz, Nerea Guadalupe, Gonzalo Azparren, Inma India, Anabel Delgado, José González, Daniela Garrido, Jesús Álvarez‐García, Juan Berrocal-Cuadrado, Elvira Mateos-Álvarez, Adela Pereda-Manso, Ángel Fernández-Collantes, David Velasco-Villanueva, Virginia García-Virto, Gregorio Labrador, Ana Zabalza, Abel Ganso, Luisa F. Álvarez-Cid, David C. Noriega, Esther Cano, Maddalena Pasini, Patricia Galan, Alejandro Madrid, Elena Camio, M. De Miguel, Ivette Chocrón, Dina Butron, G. Vidal, M.T. Ferrer, Ana B. Serrano, María Gómez Rojo, Ángel M. Candela-Toha, Jose Isabel Muñoz, Ana Rita Castro, Beatriz Tena, Oscar Comino‐Trinidad, Carla Solé, Marina Vendrell, Concepción Monsalve, Joan Beltrán, P. Matute, Manuel López-Baamonde, M. Tió, JI García Sánchez, Rodrigo Molina, Diana Zamudio, Viviana Varón, Marc Vives, Kevin Regi, Silvia Torres, Arystarch Makowski, Iram Ahmed, Thyra Kyere-Diabour, Marcela P. Vizcaychipi, Patil Shashank, Jaime Carungcong, Surendini Thayaparan, Tatyana Kopyeva, David E. Traul, Rafi Avitsian, Jacek B. Cywiński, Allen Keebler, Stacy Ritzman, Sandra Machado, Mariel Manlapaz, Alparslan Turan, Praveen Chahar, Elyad Ekrami, Fabio A. Rodriguez-Patarroyo, Mauro Bravo, Barak Cohen, Hani Essber, Ruben Agudelo-Jimenez, Eva Rivas, Dominic W. Pelle, Michael J. Rosen, Emre Görgün, Partha Saha, Azfar Niazi, Andrew Volio, Daniel D. Kim, Jorge Araujo‐Duran, Eitan Scher, Manal M. Hassan, Gandhivarma Subramanium, Juan P. Cata, German Corrales, Ronaldo V. Purugganan, Peter Norman, Olakunle Idowu, Camila Teixeira, Syed Nasim, Edward Noguera, Santiago V. Luis, Mario Pimentel, Snehal Raut, Sameep Raj Baral, Ricardo Plata Aguilar, Luz Divina Arazo, Andres Giraldo, Steven Minear, Tristan Weaver, Sergio D. Bergese, Alberto Uribe, Joshua D. Pasek, Jaume Borrell-Vega, Caitlin Hatten, Olufunke Dada, Johnny McKeown, Juan Fiorda‐Diaz, Marco Echeverria-Villalobos, Michael Essandoh, Priya A. Kumar, Harendra Arora, M S Bhatia, Scott A. Miller, Bruce Cusson, Lynne Harris, Sydney E. Rose, Vincent Pinkert, Shamsuddin Akhtar, Miriam Treggiari, Michael Kampp
Bibliographic record
VenueAnnals of Internal Medicine · 2023
Typearticle
Languageen
FieldMedicine
TopicCardiac, Anesthesia and Surgical Outcomes
Canadian institutionsUniversity of ManitobaKingston Health Sciences CentreWestern UniversityMcMaster UniversityQueen's UniversityCentre Hospitalier de l’Université de MontréalPopulation Health Research Institute
FundersCanadian Institutes of Health ResearchDepartment of Surgery, University of ManitobaNational Health and Medical Research CouncilUniversitat Autònoma de BarcelonaMedizinische Universität WienUniversiti MalayaUniwersytet Jagielloński Collegium MedicumHospital de Clínicas de Porto AlegreMedical Research CouncilUniversität WienResearch Grants Council, University Grants CommitteeGentofte HospitalNational Institute for Health and Care ResearchUniversity of OxfordUniversidade Federal do Rio Grande do SulQueen's UniversityMcMaster UniversityUniversity of Cape TownSaint Petersburg State UniversityCleveland Clinic
KeywordsMedicineAnesthesiaIntensive care medicineSurgery
Abstract
BACKGROUND: Among patients having noncardiac surgery, perioperative hemodynamic abnormalities are associated with vascular complications. Uncertainty remains about what intraoperative blood pressure to target and how to manage long-term antihypertensive medications perioperatively. OBJECTIVE: To compare the effects of a hypotension-avoidance and a hypertension-avoidance strategy on major vascular complications after noncardiac surgery. DESIGN: Partial factorial randomized trial of 2 perioperative blood pressure management strategies (reported here) and tranexamic acid versus placebo. (ClinicalTrials.gov: NCT03505723). SETTING: 110 hospitals in 22 countries. PATIENTS: 7490 patients having noncardiac surgery who were at risk for vascular complications and were receiving 1 or more long-term antihypertensive medications. INTERVENTION: In the hypotension-avoidance strategy group, the intraoperative mean arterial pressure target was 80 mm Hg or greater; before and for 2 days after surgery, renin-angiotensin-aldosterone system inhibitors were withheld and the other long-term antihypertensive medications were administered only for systolic blood pressures 130 mm Hg or greater, following an algorithm. In the hypertension-avoidance strategy group, the intraoperative mean arterial pressure target was 60 mm Hg or greater; all antihypertensive medications were continued before and after surgery. MEASUREMENTS: The primary outcome was a composite of vascular death and nonfatal myocardial injury after noncardiac surgery, stroke, and cardiac arrest at 30 days. Outcome adjudicators were masked to treatment assignment. RESULTS: = 0.92). Results were consistent for patients who used 1 or more than 1 antihypertensive medication in the long term. LIMITATION: Adherence to the assigned strategies was suboptimal; however, results were consistent across different adherence levels. CONCLUSION: In patients having noncardiac surgery, our hypotension-avoidance and hypertension-avoidance strategies resulted in a similar incidence of major vascular complications. PRIMARY FUNDING SOURCE: Canadian Institutes of Health Research, National Health and Medical Research Council (Australia), and Research Grant Council of Hong Kong.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
metaresearch head score (Codex)0.001
metaresearch head score (Gemma)0.003
Version: codex-gemma-dda1882f352aValidation status: machine_predicted_unvalidated
Candidate categoriesnone
Consensus categoriesnone
DomainCandidate signal: none · Consensus signal: none
Study designCandidate signal: Observational · Consensus signal: Observational
GenreCandidate signal: Empirical · Consensus signal: Empirical
Teacher disagreement score0.383
Threshold uncertainty score0.808
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
Opus teacher head0.097
GPT teacher head0.350
Teacher spread0.253 · how far apart the two teachers sit on this one work
Validation status
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
The models applied no category: nothing in the taxonomy fit this work.
Study designObservational
Domainnot available
GenreEmpirical
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".
Quick stats
Citations156
Published2023
Admission routes3
Has abstractyes