Intraoperative mortality has decreased by a factor of a 100 during the last century, and deaths during surgery are now rare. In contrast, mortality within the first postoperative month remains common, with about 2% of patients having inpatient noncardiac surgery dying within 30 days after surgery—corresponding to more than 4 million deaths per year worldwide. Postoperative deaths are most strongly associated with complications, including myocardial and acute kidney injury. The risk for postoperative myocardial and acute kidney injury is largely determined by baseline factors.4,5  But intraoperative and postoperative hypotension are also associated with myocardial and acute kidney injury, and mortality6–12 —and differ from other risk factors in being potentially modifiable.

Hypotension during and after noncardiac surgery is multifactorial in origin, involving combinations of patient, pharmacologic, and procedural factors....

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