Effectiveness of hypotension prediction index in reducing postoperative organ hypoperfusion-related complications in non-cardiac surgery: a meta-analysis of randomized controlled trials

BACKGROUND: Intraoperative hypotension during non-cardiac surgery is associated with postoperative complications such as acute kidney injury (AKI), myocardial injury, and stroke, which may increase mortality and severe adverse outcomes. Although the Hypotension Prediction Index (HPI) may help reduce intraoperative hypotension, its clinical value in lowering the incidence of these complications remains uncertain. This meta-analysis evaluates whether HPI-guided hemodynamic management reduces major postoperative complications (including AKI, cardiorenal, and cerebrovascular events) in adult patients undergoing non-cardiac surgery. METHODS: A systematic search was conducted in PubMed, EMBASE, Cochrane Library, and Web of Science, to identify RCTs assessing HPI in non-cardiac surgery. The outcomes encompassed the incidence of postoperative complications such as AKI, myocardial injury after non-cardiac surgery (MINS), stroke and 30-day mortality. Pooled effect estimates, including odds ratios (ORs) with 95% confidence intervals (95% CIs), were calculated using either fixed-effects or random-effects models based on heterogeneity assessments. Sensitivity analyses were performed by excluding trials with a high or unclear risk of bias to evaluate the robustness of the findings. RESULTS: A total of 10 RCTs involving 1746 participants were included. The results revealed no statistically significant difference in incidence of AKI (OR: 0.85; 95%CI: 0.65 to 1.10; P=0.21), MINS(OR: 0.62; 95%CI: 0.36 to 1.06; P=0.08), stroke (OR: 0.63; 95%CI: 0.20 to 1.98; P=0.42), and 30-day mortality (OR: 0.87; 95%CI: 0.32 to 2.34; P=0.78) between HPI group and control group. CONCLUSIONS: Hemodynamic management guided by the HPI in adults undergoing non-cardiac surgery does not significantly reduce the incidence of major postoperative complications compared to standard care.