Noninvasive Models for Predicting Postoperative Hypotension in Thoracic Surgery

In thoracic surgery, a multiparameter predictive model using noninvasive hemodynamic profiling accurately identifies patients at high risk for early postoperative hypotension.

The prospective observational study reports strong discrimination for hypotension within 24 hours after surgery; the multiparameter predictive model performed at a clinically meaningful level, enabling perioperative and emergency teams to target monitoring to high‑risk patients.

Unlike single‑parameter monitoring that often focuses on isolated volume markers, the noninvasive multiparameter profile integrates volumetric and cardiac‑function signals to improve discrimination and clinical net benefit. The combined model outperformed individual indices in distinguishing patients who will develop hypotension—a distinction that matters for triage and allocation of monitoring resources and marks a measurable advance in early risk stratification.

Key predictors included the inferior vena cava collapsibility index, post‑anesthetic left ventricular stroke work (PA_LVSW), post‑anesthetic cardiac output and stroke volume (PA_CO, PA_SV), and systemic vascular resistance, together with clinical covariates such as baseline mean arterial pressure and ASA physical status.

The study enrolled 100 video‑assisted thoracoscopic surgery patients and defined early postoperative hypotension within 24 hours (mean arterial pressure ≤65 mmHg or ≥30% reduction from baseline) as the primary endpoint. Model discrimination was reported as AUC 0.94, sensitivity 83.3%, specificity 89.1%, and internal bootstrap validation yielded mean AUC 0.932±0.022—indicating high predictive performance in this cohort.

For emergency physicians and perioperative teams, implementation begins with targeted measurement shortly after emergence: obtain noninvasive continuous hemodynamic monitoring and an IVC assessment to populate the risk model. Use elevated IVCCI and low PA_LVSW within a point‑based risk calculation or nomogram to guide monitoring intensity, prioritize focused volume assessment and guided fluid therapy, and consider earlier vasopressor initiation when myocardial performance is impaired.

Centering workflows on early noninvasive profiling helps identify patients at imminent risk of hypotension and prioritize timely interventions.

Key Takeaways:

• A noninvasive multiparameter model combining IVCCI, PA_LVSW, baseline MAP, and ASA status predicts early hypotension substantially better than single measures.

• Patients undergoing thoracic surgery and the perioperative/ED teams caring for them stand to benefit from earlier, more accurate risk stratification.

• Incorporate early post‑emergence noninvasive hemodynamic assessment into perioperative pathways and prioritize external validation and protocolized response plans.