AUTHOR=Daum Nils , Bill Daniel , Thiele Moritz , Felber Julian , von Wedel Dario , Spies Claudia , Balzer Felix , Mörgeli Rudolf , Hunsicker Oliver , Müller Anika , Contag Dennis , Pohrt Anne , Bald Annika , Kayser Max , Treskatsch Sascha , Markus Maximilian 
  
TITLE=Preoperative patient risk factors for intraoperative hypotension: a systematic review and meta-analysis
  
JOURNAL=Frontiers in Cardiovascular Medicine
  
VOLUME=Volume 12 - 2025
  
YEAR=2025
  
URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2025.1709004
  
DOI=10.3389/fcvm.2025.1709004
  
ISSN=2297-055X
  
ABSTRACT=BackgroundIntraoperative hypotension (IOH) presents a risk factor for postoperative organ dysfunction. However, as a unique definition of IOH is still missing, the influence of individual preoperative patient characteristics on IOH remains poorly understood. This systematic review aimed to examine the variability in IOH definitions and to identify preoperative risk factors associated with IOH.MethodsA systematic literature search was conducted from inception to March 2, 2024. Studies reporting on IOH and from which the association between preoperative characteristics and IOH in cardiac and non-cardiac surgery could be derived were included. Odds ratios (ORs) were either extracted directly or calculated based on available patient-level data. Pooled estimates were generated using a random-effects model.ResultsOut of 7,361 screened studies, 78 met the inclusion criteria. Heterogeneity was high due to varying IOH definitions. 14 preoperative factors were included in the meta-analysis. Older age (OR 1.03, 95% CI 1.02–1.04) and female sex (OR 1.16, 95% CI 1.08–1.24) were associated with increased IOH risk. ASA-II was linked to lower risk compared to ASA-III (OR 0.80, 95% CI 0.70–0.91). Diabetes mellitus (OR 1.18, 95% CI 1.04–1.35) and arterial hypertension (OR 1.56, 95% CI 1.33–1.83) were independent predictors. ACE inhibitor use (angiotensin-converting enzyme inhibitor use; OR 1.63, 95% CI 1.42–1.88), angiotensin receptor blocker (ARB) use (OR 1.38, 95% CI 1.01–1.89), and emergent surgery (OR 1.25, 95% CI 1.09–1.42) also increased IOH incidence. The risk of bias was low to moderate.ConclusionThe substantial variability in IOH definitions and several preoperative IOH influencing patient characteristics highlight the need for standardized criteria to improve comparability and guide personalized perioperative management.Systematic Review Registrationidentifier PROSPERO CRD42024514229.