Pulmonary hypertension and associated outcomes in noncardiac surgery: A systematic review and meta-analysis

BACKGROUND: Some studies suggest that patients with pulmonary hypertension (PH) may be at higher risk of complications and death after noncardiac surgery. However, the magnitude of these associations is unclear. OBJECTIVES: To determine the associations between PH and adverse outcomes after noncardiac surgery. METHODS: We searched PUBMED and EMBASE for studies published from January 1970 to April 2022. We included studies that reported the association between PH and one or more outcomes of interest occurring after noncardiac surgery. Data were pooled using random-effects models and reported as summary odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS: Eighteen studies met eligibility criteria (n=18,214,760). PH was independently associated with mortality (adjusted odds ratio [OR] 2.09; 95% CI, 1.51-2.90; I²=98%; 8 studies). PH was associated with a higher unadjusted risk of deep venous thrombosis (OR 4.02; 95% CI, 2.14-7.54; I²=85%; 3 studies), pulmonary embolism (OR 4.16; 95% CI, 3.23-5.36; I²=69%; 7 studies), myocardial infarction (OR 1.49; 95% CI, 1.44-1.54; I²=0%; 5 studies), congestive heart failure or cardiogenic shock (OR 3.37; 95% CI, 1.73-6.60; I²=34%; 5 studies), length of hospital stay (mean difference 1.97 days; 95% CI, 0.81-3.12; I²=99%; 5 studies), and delayed extubation (OR 5.98; 95% CI, 1.70-21.02; I²=3%; 3 studies). PH was associated with lower unadjusted risk of postoperative stroke (OR 0.93; 95% CI, 0.88-0.98; I²=0%; 3 studies). CONCLUSION: PH is a predictor of morbidity and mortality after noncardiac surgery. High quality studies are needed to determine effective strategies for reducing postoperative complications in this population.