Intraoperative hypotension trajectories and their predictive value for major postoperative complications: a retrospective cohort study

Background: 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. Methods: 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