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General anaesthesia versus monitored anaesthesia care and postoperative outcome in patients with elevated right ventricular systolic pressure undergoing low-risk surgical procedures: a retrospective single-centre cohort study

Year: 2026

Type: article

Abstract: Background Pulmonary hypertension, often indicated before surgery by elevated right ventricular systolic pressure (RVSP) on echocardiography, is associated with increased perioperative risk. For low-risk procedures in which either general anaesthesia or monitored anaesthesia care may be selected, comparative data on postoperative outcomes are limited. Methods We conducted a single-centre retrospective observational cohort study of 4962 adults with RVSP >50 mm Hg who underwent low-risk procedures. Eligible procedures included endoscopy, bronchoscopy, catheterisation laboratory interventions, and peripheral surgeries. The primary outcome was a composite of acute kidney injury, acute myocardial injury, or 30-day mortality. Analyses used multivariable logistic regression and inverse probability of treatment weighting based on preoperative covariates. Intraoperative variables were evaluated as potential mediators in sensitivity analyses. Results Of the 4962 patients, 2473 received general anaesthesia and 2489 received monitored anaesthesia care. In preoperative-adjusted models, general anaesthesia was associated with higher odds of major complications (odds ratio, 1.24; 95% confidence interval [95% CI], 1.02–1.51; P =0.030). A doubly robust inverse probability weighted model produced similar results (odds ratio, 1.36; 95% CI, 1.08–1.70; P =0.0076), with estimated risks of 39.7% vs 32.7%. Incorporating intraoperative factors such as anaesthesia duration, vasopressor use, and fluid balance attenuated the association (odds ratio, 1.00; 95% CI, 0.81–1.23). No significant interactions were observed by emergency status or preoperative pulmonary hypertension-targeted therapy. Conclusions After adjustment for preoperative risk and evaluating intraoperative mediators, we found no evidence of a statistically significant difference in major postoperative complications between general anaesthesia and monitored anaesthesia care in adults with elevated RVSP undergoing low-risk procedures.

Source: BJA Open

DOI: 10.1016/j.bjao.2026.100529