Intraoperative hypotension and postoperative neurocognitive impairment in surgical patients with sepsis: A retrospective observational study
- 1Department of Anesthesiology, the First Affiliated Hospital of Anhui Medical University, Anhui 230022, China
Abstract
Background: Postoperative neurocognitive impairment is frequently observed in critically ill surgical patients with sepsis, but its perioperative contributors remain insufficiently defined. This study evaluated the associations of intraoperative hypotension and disease severity—assessed using the Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores—with postoperative neurocognitive impairment and 28-day all-cause mortality in this population.
Methods: This single-center retrospective observational study included 285 adult patients with sepsis who were admitted to the intensive care unit after surgery. Postoperative neurocognitive impairment was operationally defined as new-onset disturbance of consciousness, attention, orientation, or mental status during the first postoperative intensive care unit stay, after excluding primary central nervous system disease, overt metabolic encephalopathy, and direct sedative or analgesic effects. Univariable and multivariable logistic regression analyses were performed to identify factors associated with postoperative neurocognitive impairment. A secondary analysis was conducted among patients who developed postoperative neurocognitive impairment to explore factors associated with 28-day all-cause mortality.
Results: Postoperative neurocognitive impairment occurred in 140 of 285 patients (49.1%). In multivariable analysis, older age, longer duration of intraoperative hypotension, greater intraoperative hypotension burden, higher SOFA score, and higher APACHE II score were independently associated with postoperative neurocognitive impairment. Among patients with postoperative neurocognitive impairment, intraoperative hypotension exposure and higher SOFA and APACHE II scores were independently associated with 28-day all-cause mortality.
Conclusions: Operationally defined postoperative neurocognitive impairment was common in surgical patients with sepsis admitted to the intensive care unit after surgery. Intraoperative hypotension exposure and higher SOFA and APACHE II scores were associated with postoperative neurocognitive impairment and 28-day all-cause mortality, suggesting that perioperative hemodynamic instability may have prognostic relevance in this high-risk population.
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BibTeX
@article{wang2026intraoperative,
title = {{Intraoperative hypotension and postoperative neurocognitive impairment in surgical patients with sepsis: A retrospective observational study}},
author = {Chen Wang and Jingwen Ning and Yanchao Tang and Qiying Shen},
journal = {Journal of Anesthesia and Translational Medicine},
year = {2026},
month = oct,
doi = {10.1016/j.jatmed.2026.09.003},
url = {https://doi.org/10.1016/j.jatmed.2026.09.003},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Intraoperative hypotension and postoperative neurocognitive impairment in surgical patients with sepsis: A retrospective observational study
AU - Chen Wang
AU - Jingwen Ning
AU - Yanchao Tang
AU - Qiying Shen
PY - 2026
DA - 2026/10/26
JO - Journal of Anesthesia and Translational Medicine
DO - 10.1016/j.jatmed.2026.09.003
UR - https://doi.org/10.1016/j.jatmed.2026.09.003
AB - Background: Postoperative neurocognitive impairment is frequently observed in critically ill surgical patients with sepsis, but its perioperative contributors remain insufficiently defined. This study evaluated the associations of intraoperative hypotension and disease severity—assessed using the Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores—with postoperative neurocognitive impairment and 28-day all-cause mortality in this population. Methods: This single-center retrospective observational study included 285 adult patients with sepsis who were admitted to the intensive care unit after surgery. Postoperative neurocognitive impairment was operationally defined as new-onset disturbance of consciousness, attention, orientation, or mental status during the first postoperative intensive care unit stay, after excluding primary central nervous system disease, overt metabolic encephalopathy, and direct sedative or analgesic effects. Univariable and multivariable logistic regression analyses were performed to identify factors associated with postoperative neurocognitive impairment. A secondary analysis was conducted among patients who developed postoperative neurocognitive impairment to explore factors associated with 28-day all-cause mortality. Results: Postoperative neurocognitive impairment occurred in 140 of 285 patients (49.1%). In multivariable analysis, older age, longer duration of intraoperative hypotension, greater intraoperative hypotension burden, higher SOFA score, and higher APACHE II score were independently associated with postoperative neurocognitive impairment. Among patients with postoperative neurocognitive impairment, intraoperative hypotension exposure and higher SOFA and APACHE II scores were independently associated with 28-day all-cause mortality. Conclusions: Operationally defined postoperative neurocognitive impairment was common in surgical patients with sepsis admitted to the intensive care unit after surgery. Intraoperative hypotension exposure and higher SOFA and APACHE II scores were associated with postoperative neurocognitive impairment and 28-day all-cause mortality, suggesting that perioperative hemodynamic instability may have prognostic relevance in this high-risk population.
SN - 2957-3912
ER -