{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T05:49:00Z","timestamp":1788587340297,"version":"build-2803163510"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T00:00:00Z","timestamp":1768348800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Intraoperative hypotension (IOH) is a common hemodynamic disturbance during major non-cardiac surgery, yet the prognostic significance of different temporal blood pressure patterns remains unclear. This study aimed to identify distinct IOH trajectories using group-based trajectory modeling (GBTM) and to evaluate their independent and incremental predictive value for major postoperative complications in high-risk surgical patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study of 789 adults undergoing elective major abdominal, urologic, or gynecologic surgery between January 2018 and December 2023. Continuous invasive minute-by-minute mean arterial pressure (MAP) recordings were extracted from the anesthesia information management system. IOH was defined as MAP &amp;lt;65\u202fmmHg. GBTM modeled MAP over absolute intraoperative time using polynomial time functions to identify three latent IOH trajectories based on duration and recurrence: transient mild (&amp;lt;10\u202fmin), moderate sustained (10\u201330\u202fmin), and prolonged\/fluctuating (&amp;gt;30\u202fmin or \u22653 episodes). The primary composite outcome included acute kidney injury, postoperative delirium, unplanned ICU admission within 48\u202fh, and 30-day all-cause mortality. Associations were examined using multivariable logistic regression, and predictive performance was evaluated using ROC curves, calibration, bootstrap internal validation, and decision curve analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A clear exposure-response relationship was observed across trajectory groups: the primary composite complication occurred in 13.4% of patients in the transient mild group, 20.8% in the moderate sustained group, and 30.7% in the prolonged\/fluctuating group (p for trend &amp;lt;0.001). Compared with transient mild hypotension, adjusted odds ratios were 1.58 (95% CI 1.03\u20132.43) for moderate sustained and 2.42 (95% CI 1.54\u20133.80) for prolonged\/fluctuating trajectories. Incorporating trajectory classification into a clinical model markedly improved discrimination (AUC 0.860 vs. 0.578), calibration, and net clinical benefit compared with conventional IOH measures alone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Distinct intraoperative hypotension trajectories derived from high-resolution arterial pressure data were strongly and independently associated with major postoperative complications and substantially enhanced predictive accuracy beyond standard IOH metrics. Trajectory-based hemodynamic profiling may support individualized blood pressure management and early perioperative risk stratification.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2025.1739832","type":"journal-article","created":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T06:41:07Z","timestamp":1768372867000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Intraoperative hypotension trajectories and their predictive value for major postoperative complications: a retrospective cohort study"],"prefix":"10.3389","volume":"12","author":[{"given":"Yingbo","family":"Ren","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University","place":["Luzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University","place":["Luzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University","place":["Luzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengwei","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University","place":["Luzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongyan","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University","place":["Luzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,14]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1186\/s12871-022-01605-9","article-title":"Reported definitions of intraoperative hypotension in adults undergoing non-cardiac surgery under general anaesthesia: a review","volume":"22","author":"Weinberg","year":"2022","journal-title":"BMC Anesthesiol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1186\/s13741-023-00318-y","article-title":"Incidence of intraoperative hypotension during non-cardiac surgery in community anesthesia practice: a retrospective observational analysis","volume":"12","author":"Saasouh","year":"2023","journal-title":"Perioper Med"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"264","DOI":"10.1016\/j.bja.2024.04.046","article-title":"PeriOperative quality initiative (POQI) international consensus statement on 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hypotension as potential separate risk factors for the adverse outcome: a cohort study","volume":"37","author":"Czajka","year":"2023","journal-title":"J Anesth"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1146\/annurev-clinpsy-081122-012416","article-title":"Recent advances in group-based trajectory modeling for clinical research","volume":"20","author":"Nagin","year":"2024","journal-title":"Annu Rev Clin Psychol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"e29934","DOI":"10.1016\/j.heliyon.2024.e29934","article-title":"Combined blood pressure and heart rate trajectories are associated with prognosis in critically ill patients with acute aortic dissection: a group-based multi-trajectory analysis","volume":"10","author":"Shen","year":"2024","journal-title":"Heliyon"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"725","DOI":"10.1186\/s12967-024-05481-4","article-title":"Predictive ability of hypotension prediction index and 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