Intraoperative hypotension burden and early postoperative recovery after uniportal video-assisted thoracoscopic lung resection: a retrospective cohort study.

OBJECTIVE: Intraoperative hypotension is common during general anesthesia and has been associated with postoperative organ injury. Its relationship with early postoperative analgesic requirement after uniportal video-assisted thoracoscopic surgery (VATS) remains unclear. This study aimed to evaluate whether cumulative intraoperative hypotension, defined primarily as duration of mean arterial pressure (MAP) <65 mmHg, is associated with postoperative analgesic consumption and early recovery outcomes after elective uniportal VATS lung resection. METHODS: This single-center retrospective observational cohort study included 420 adult patients who had undergone elective uniportal VATS lung resection with standardized total intravenous anesthesia, thoracic paravertebral block, and postoperative intravenous patient-controlled analgesia (PCA). The primary exposure was cumulative duration of MAP < 65 mmHg, modeled per 10-min increase. The primary outcome was cumulative opioid consumption within 24 h postoperatively, standardized to intravenous morphine milligram equivalents. Secondary outcomes included resting pain, successful PCA dose deliveries, postoperative nausea and vomiting (PONV), and rescue analgesia. Multivariable regression models were used to evaluate adjusted associations. RESULTS: Of 420 patients, 134 (31.9%) experienced at least one episode of MAP <65 mmHg. After full adjustment, each 10-min increase in MAP <65 mmHg duration was associated with higher 24-h opioid consumption [β = 1.513 mg; 95% confidence interval (CI), 0.877-2.149; P < 0.001], more successful PCA dose deliveries (β = 0.230; 95% CI, 0.124-0.336; P < 0.001), increased odds of PONV (OR, 1.63; 95% CI, 1.33-2.00; P < 0.001), and increased odds of rescue analgesic use (OR, 1.31; 95% CI, 1.10-1.58; P = 0.003). No significant association was observed with 24-h resting pain score. CONCLUSION: Greater cumulative duration of intraoperative MAP <65 mmHg was associated with higher early postoperative opioid requirement, greater analgesic demand, and increased PONV after uniportal VATS lung resection. These findings identify prolonged intraoperative hypotension as a potential marker of less favorable early recovery. Prospective studies are needed to determine whether the associations are causal and whether blood pressure-targeted interventions improve recovery.