Risk factors for unanticipated hypertension during emergence from general anesthesia in elderly surgical patients: A retrospective cohort analysis

Unanticipated hypertension in the postanesthesia care unit (PACU) refers to acute blood pressure elevation in patients whose preoperative baseline blood pressure was normal, possibly resulting in adverse postoperative complications. This study aimed to identify potential factors and the impact of unanticipated hypertension during emergence from general anesthesia in the elderly surgical population. A retrospective study was done at the Affiliated BenQ Hospital of Nanjing Medical University. Elderly surgical patients who had been admitted to the PACU for recovery from general anesthesia were enrolled. The demographic and clinical variables of elderly patients were systematically analyzed. All elderly patients were divided into the case group and the control group based on whether they experienced unanticipated hypertension during the anesthesia recovery period. Conditional multivariate logistic regression was performed to investigate factors responsible for unanticipated hypertension during the general anesthesia recovery period. Among the 840 enrolled elderly patients, 212 (25.2%) developed unanticipated hypertension during emergence from general anesthesia. Multivariate logistic regression analyses, advanced age (odds ratio [OR] = 2.016, 95% confidence interval [CI]: 1.458–2.824, P  < .001), female sex (OR = 1.494, 95% CI: 1.049–2.130, P  = .026), absence of antihypertensive medication use (OR = 1.886, 95% CI: 1.319–2.717, P  = .001), orthopedic surgery (OR = 2.006, 95% CI: 1.302–3.082, P  = .002), intraoperative hypertension (OR = 1.587, 95% CI: 1.104–2.279, P  = .012), urinary catheterization (OR = 3.674, 95% CI: 2.222–6.350, P  < .001), absence of patient-controlled analgesia (OR = 2.774, 95% CI: 1.887–4.094, P  < .001), postoperative pain (OR = 5.692, 95% CI: 3.003–11.006, P  < .001), and postoperative agitation (OR = 1.878, 95% CI: 1.263–2.784, P  = .002) were independently associated with unanticipated hypertension during anesthetic emergence in geriatric surgical patients. Furthermore, those who experienced unanticipated hypertension exhibited significantly higher rates of delayed extubation and prolonged stays in the PACU. Advanced age, female sex, absence of preoperative antihypertensive medication, orthopedic surgery, intraoperative hypertension, urinary catheterization, postoperative pain, and postoperative agitation were independently associated with an increased risk of unanticipated hypertension during emergence from anesthesia in elderly surgical patients. These findings underscore the importance of proactive and well-structured postoperative blood pressure management strategies in clinical anesthetic practice.