Impact of different intraoperative MAP management goals on the development of severe postoperative complications in elderly hypertensive patients

Abstract Background Hypertension is highly prevalent among elderly surgical patients and is associated with impaired intraoperative hemodynamic stability and an elevated risk of postoperative complications. Although mean arterial pressure (MAP) is a key determinant of organ perfusion, the optimal intraoperative MAP target for elderly hypertensive patients has not been clearly defined. Methods This retrospective study analyzed clinical data from elderly hypertensive patients (n = 354). Patients were categorized into three groups based on intraoperative MAP: 65–75 mmHg, 75–85 mmHg, and 85–95 mmHg. The incidence of severe postoperative complications was compared across groups. Univariable and multivariable logistic regression analyses were performed to identify factors associated with these complications, and a prediction model was developed. Results The incidence of severe postoperative complications differed among MAP groups, with the lowest rate in the 85–95 mmHg group (8.9%) and the highest in the 65–75 mmHg group (21.7%). Multivariable analysis indicated that maintaining MAP at 85–95 mmHg was independently associated with a lower risk of severe complications, whereas a history of diabetes was associated with an increased risk. The prediction model demonstrated satisfactory clinical applicability. Conclusion In this retrospective analysis, maintaining intraoperative MAP within 85–95 mmHg was associated with a lower incidence of severe postoperative complications in elderly hypertensive patients. These findings provide evidence for intraoperative MAP selection in this population.