{"id":"https://openalex.org/W7224108323","doi":"https://doi.org/10.3389/fmed.2026.1972338","title":"Severity, duration, and pattern of intraoperative hypotension and early postoperative cognitive decline in adults undergoing non-cardiac surgery: a prospective observational cohort study","display_name":"Severity, duration, and pattern of intraoperative hypotension and early postoperative cognitive decline in adults undergoing non-cardiac surgery: a prospective observational cohort study","publication_year":2026,"publication_date":"2026-10-28","ids":{"openalex":"https://openalex.org/W7224108323","doi":"https://doi.org/10.3389/fmed.2026.1972338"},"language":"en","primary_location":{"id":"doi:10.3389/fmed.2026.1972338","doi":"https://doi.org/10.3389/fmed.2026.1972338","is_oa":true,"landing_page_url":"https://doi.org/10.3389/fmed.2026.1972338","pdf_url":"https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2026.1972338/pdf","source":{"id":"https://openalex.org/S2597052008","display_name":"Frontiers in Medicine","issn_l":"2296-858X","issn":["2296-858X"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","norway-1","poland-70","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320527","host_organization_name":"Frontiers Media","host_organization_lineage":["https://openalex.org/P4310320527"],"host_organization_lineage_names":["Frontiers Media"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Frontiers in Medicine","raw_type":"journal-article"},"volume":null,"type":"article","is_traditional":true,"indexed_in":["crossref","doaj"],"open_access":{"is_oa":true,"oa_status":"gold","oa_url":"https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2026.1972338/pdf","any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5160009712","display_name":"Joud Firas Alnajjar","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I163074564","display_name":"Gulf Medical University","ror":"https://ror.org/02kaerj47","country_code":"AE","type":"education","lineage":["https://openalex.org/I163074564"]}],"countries":["AE"],"is_corresponding":false,"raw_author_name":"Joud Firas Alnajjar","raw_affiliation_strings":["Department of Anesthesia Technology, College of Health Sciences, Gulf Medical University"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Anesthesia Technology, College of Health Sciences, Gulf Medical University","institution_ids":["https://openalex.org/I163074564"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5160049989","display_name":"Ghazi Gasmalla","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I163074564","display_name":"Gulf Medical University","ror":"https://ror.org/02kaerj47","country_code":"AE","type":"education","lineage":["https://openalex.org/I163074564"]}],"countries":["AE"],"is_corresponding":false,"raw_author_name":"Ghazi Gasmalla","raw_affiliation_strings":["Department of Anesthesia Technology, College of Health Sciences, Gulf Medical University"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Anesthesia Technology, College of Health Sciences, Gulf Medical University","institution_ids":["https://openalex.org/I163074564"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5160041869","display_name":"Diaaeldein Mahmoud","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I4210126887","display_name":"Thumbay Group (United Arab Emirates)","ror":"https://ror.org/030c89r84","country_code":"AE","type":"company","lineage":["https://openalex.org/I4210126887"]}],"countries":["AE"],"is_corresponding":false,"raw_author_name":"Diaaeldein Mahmoud","raw_affiliation_strings":["Department of Anaesthesiology, Thumbay University Hospital"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Anaesthesiology, Thumbay University Hospital","institution_ids":["https://openalex.org/I4210126887"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5014398868","display_name":"Marwan Ismail","orcid":"https://orcid.org/0000-0001-5692-1632","observed_orcids":["https://orcid.org/0000-0001-5692-1632"]},"institutions":[{"id":"https://openalex.org/I163074564","display_name":"Gulf Medical University","ror":"https://ror.org/02kaerj47","country_code":"AE","type":"education","lineage":["https://openalex.org/I163074564"]}],"countries":["AE"],"is_corresponding":false,"raw_author_name":"Marwan Ismail","raw_affiliation_strings":["Department of Medical Laboratory Sciences, College of Health Sciences, Gulf Medical University"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Medical Laboratory Sciences, College of Health Sciences, Gulf Medical University","institution_ids":["https://openalex.org/I163074564"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5132607790","display_name":"Ellen Safadi","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I163074564","display_name":"Gulf Medical University","ror":"https://ror.org/02kaerj47","country_code":"AE","type":"education","lineage":["https://openalex.org/I163074564"]}],"countries":["AE"],"is_corresponding":true,"raw_author_name":"Ellen Safadi","raw_affiliation_strings":["Department of Anesthesia Technology, College of Health Sciences, Gulf Medical University"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Anesthesia Technology, College of Health Sciences, Gulf Medical University","institution_ids":["https://openalex.org/I163074564"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":2,"corresponding_author_ids":["https://openalex.org/A5132607790"],"corresponding_institution_ids":["https://openalex.org/I163074564"],"apc_list":{"value":3150,"currency":"CHF","value_usd":3801},"apc_paid":{"value":3150,"currency":"CHF","value_usd":3801},"fwci":0.0,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":{"value":0.85958939,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"13","issue":null,"first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T11700","display_name":"Hemodynamic Monitoring and Therapy","score":0.6509000062942505,"subfield":{"id":"https://openalex.org/subfields/2746","display_name":"Surgery"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T11700","display_name":"Hemodynamic Monitoring and Therapy","score":0.6509000062942505,"subfield":{"id":"https://openalex.org/subfields/2746","display_name":"Surgery"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10867","display_name":"Intensive Care Unit Cognitive Disorders","score":0.2134999930858612,"subfield":{"id":"https://openalex.org/subfields/2706","display_name":"Critical Care and Intensive Care Medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11930","display_name":"Cardiac, Anesthesia and Surgical Outcomes","score":0.053199999034404755,"subfield":{"id":"https://openalex.org/subfields/2705","display_name":"Cardiology and Cardiovascular Medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/intraoperative-hypotension","display_name":"intraoperative hypotension","score":1.0},{"id":"https://openalex.org/keywords/noncardiac-surgery","display_name":"non-cardiac surgery","score":0.9629999995231628},{"id":"https://openalex.org/keywords/general-anesthesia","display_name":"general anesthesia","score":0.9610000252723694},{"id":"https://openalex.org/keywords/mean-arterial-pressure","display_name":"mean arterial pressure","score":0.8190000057220459},{"id":"https://openalex.org/keywords/cognitive-function","display_name":"cognitive function","score":0.492000013589859},{"id":"https://openalex.org/keywords/age-confounding","display_name":"age confounding","score":0.6600000262260437}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.881600022315979},{"id":"https://openalex.org/C23131810","wikidata":"https://www.wikidata.org/wiki/Q818574","display_name":"Observational study","level":2,"score":0.7005000114440918},{"id":"https://openalex.org/C188816634","wikidata":"https://www.wikidata.org/wiki/Q2113324","display_name":"Prospective cohort study","level":2,"score":0.6604999899864197},{"id":"https://openalex.org/C201903717","wikidata":"https://www.wikidata.org/wiki/Q1778788","display_name":"Cohort study","level":2,"score":0.6122999787330627},{"id":"https://openalex.org/C42219234","wikidata":"https://www.wikidata.org/wiki/Q131130","display_name":"Anesthesia","level":1,"score":0.5863000154495239},{"id":"https://openalex.org/C84393581","wikidata":"https://www.wikidata.org/wiki/Q82642","display_name":"Blood pressure","level":2,"score":0.574400007724762},{"id":"https://openalex.org/C169900460","wikidata":"https://www.wikidata.org/wiki/Q2200417","display_name":"Cognition","level":2,"score":0.5530999898910522},{"id":"https://openalex.org/C2984863031","wikidata":"https://www.wikidata.org/wiki/Q83030","display_name":"Cognitive decline","level":4,"score":0.546999990940094},{"id":"https://openalex.org/C72563966","wikidata":"https://www.wikidata.org/wiki/Q1303415","display_name":"Cohort","level":2,"score":0.5187000036239624},{"id":"https://openalex.org/C2780043718","wikidata":"https://www.wikidata.org/wiki/Q956181","display_name":"Postoperative cognitive dysfunction","level":3,"score":0.4074000120162964},{"id":"https://openalex.org/C61511704","wikidata":"https://www.wikidata.org/wiki/Q1671857","display_name":"Incidence (geometry)","level":2,"score":0.358599990606308},{"id":"https://openalex.org/C2781312054","wikidata":"https://www.wikidata.org/wiki/Q5354947","display_name":"Elective surgery","level":2,"score":0.35600000619888306},{"id":"https://openalex.org/C178853913","wikidata":"https://www.wikidata.org/wiki/Q1642137","display_name":"Hemodynamics","level":2,"score":0.33559998869895935},{"id":"https://openalex.org/C2776452961","wikidata":"https://www.wikidata.org/wiki/Q1940733","display_name":"Mean arterial pressure","level":4,"score":0.33059999346733093},{"id":"https://openalex.org/C2984915365","wikidata":"https://www.wikidata.org/wiki/Q5141203","display_name":"Cognitive impairment","level":3,"score":0.30869999527931213},{"id":"https://openalex.org/C205545832","wikidata":"https://www.wikidata.org/wiki/Q17156455","display_name":"Young adult","level":2,"score":0.30799999833106995},{"id":"https://openalex.org/C167135981","wikidata":"https://www.wikidata.org/wiki/Q2146302","display_name":"Retrospective cohort study","level":2,"score":0.29490000009536743},{"id":"https://openalex.org/C141071460","wikidata":"https://www.wikidata.org/wiki/Q40821","display_name":"Surgery","level":1,"score":0.2849000096321106},{"id":"https://openalex.org/C185711340","wikidata":"https://www.wikidata.org/wiki/Q5347381","display_name":"Effects of sleep deprivation on cognitive performance","level":3,"score":0.27649998664855957},{"id":"https://openalex.org/C194828623","wikidata":"https://www.wikidata.org/wiki/Q2861470","display_name":"Emergency medicine","level":1,"score":0.2632000148296356}],"mesh":[],"locations_count":2,"locations":[{"id":"doi:10.3389/fmed.2026.1972338","doi":"https://doi.org/10.3389/fmed.2026.1972338","is_oa":true,"landing_page_url":"https://doi.org/10.3389/fmed.2026.1972338","pdf_url":"https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2026.1972338/pdf","source":{"id":"https://openalex.org/S2597052008","display_name":"Frontiers in Medicine","issn_l":"2296-858X","issn":["2296-858X"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","norway-1","poland-70","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320527","host_organization_name":"Frontiers Media","host_organization_lineage":["https://openalex.org/P4310320527"],"host_organization_lineage_names":["Frontiers Media"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Frontiers in Medicine","raw_type":"journal-article"},{"id":"pmh:oai:doaj.org/article:9ee8675466054889b178f756ea493b30","doi":null,"is_oa":false,"landing_page_url":"https://doaj.org/article/9ee8675466054889b178f756ea493b30","pdf_url":null,"source":{"id":"https://openalex.org/S4306401280","display_name":"DOAJ (DOAJ: Directory of Open Access Journals)","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"Frontiers in Medicine, Vol 13 (2026)","raw_type":"article"}],"best_oa_location":{"id":"doi:10.3389/fmed.2026.1972338","doi":"https://doi.org/10.3389/fmed.2026.1972338","is_oa":true,"landing_page_url":"https://doi.org/10.3389/fmed.2026.1972338","pdf_url":"https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2026.1972338/pdf","source":{"id":"https://openalex.org/S2597052008","display_name":"Frontiers in Medicine","issn_l":"2296-858X","issn":["2296-858X"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","norway-1","poland-70","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320527","host_organization_name":"Frontiers Media","host_organization_lineage":["https://openalex.org/P4310320527"],"host_organization_lineage_names":["Frontiers Media"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Frontiers in Medicine","raw_type":"journal-article"},"sustainable_development_goals":[{"display_name":"Good health and well-being","score":1.0,"id":"https://metadata.un.org/sdg/3"}],"study_designs":[{"display_name":"Observational Study","id":"https://openalex.org/study-designs/observational-study"}],"awards":[],"funders":[],"has_content":{"pdf":true,"grobid_xml":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7224108323.pdf","grobid_xml":"https://content.openalex.org/works/W7224108323.grobid-xml"},"referenced_works_count":23,"referenced_works":["https://openalex.org/W1847168837","https://openalex.org/W1966653619","https://openalex.org/W2029975045","https://openalex.org/W2098001175","https://openalex.org/W2101559962","https://openalex.org/W2123067467","https://openalex.org/W2142823558","https://openalex.org/W2149615621","https://openalex.org/W2159813665","https://openalex.org/W2162055755","https://openalex.org/W2165758561","https://openalex.org/W2419112980","https://openalex.org/W2541386048","https://openalex.org/W2806277479","https://openalex.org/W2808555578","https://openalex.org/W2809427753","https://openalex.org/W2891930107","https://openalex.org/W3047352812","https://openalex.org/W3089761878","https://openalex.org/W3132683270","https://openalex.org/W4220767165","https://openalex.org/W4280561468","https://openalex.org/W7118949660"],"related_works":["https://openalex.org/W6921391175","https://openalex.org/W4367624988","https://openalex.org/W3089761878","https://openalex.org/W3104808192","https://openalex.org/W2891930107","https://openalex.org/W2061620273","https://openalex.org/W3159453611","https://openalex.org/W4398168793","https://openalex.org/W7123594044","https://openalex.org/W4283119095"],"abstract_inverted_index":{"Introduction":[0],"Intraoperative":[1],"hypotension":[2,177,190,251],"(IOH)":[3],"is":[4],"known":[5],"to":[6,17,26,240],"pose":[7],"risks":[8],"for":[9],"myocardial":[10],"and":[11,77,85,103,110,129,174,191,220,248,280,307,329,333],"renal":[12],"injury,":[13],"but":[14,154],"its":[15],"links":[16],"early":[18],"postoperative":[19,112],"cognitive":[20,147],"decline":[21],"(ePOCD)":[22],"are":[23],"ambiguous":[24],"due":[25],"varying":[27],"definitions":[28,301],"of":[29,121,142,164,176,224,233,250,278,302,311,322,326],"IOH":[30,62,124,165,303],"across":[31],"studies.":[32],"Method":[33],"This":[34],"prospective":[35],"observational":[36],"cohort":[37],"study":[38,60],"at":[39],"a":[40,64,195,207,230],"tertiary":[41],"teaching":[42],"hospital":[43],"in":[44,66,140,186,192,204,237,256,265,304],"Ajman,":[45],"United":[46],"Arab":[47],"Emirates,":[48],"involved":[49],"261":[50],"adults":[51],"undergoing":[52],"elective":[53],"non-cardiac":[54],"surgeries":[55],"under":[56],"general":[57],"anaesthesia.":[58],"The":[59,116,226],"defined":[61],"as":[63,125,285],"decrease":[65],"mean":[67],"arterial":[68],"pressure":[69],"(MAP)":[70],"exceeding":[71],"20%":[72],"from":[73,275],"the":[74,99,162,172,266,276,309,323],"pre-induction":[75],"baseline":[76],"categorised":[78],"it":[79],"by":[80,158,316],"severity":[81,173],"(mild,":[82],"moderate,":[83],"severe)":[84],"duration/pattern":[86],"(controlled":[87],"episodes,":[88,90],"prolonged":[89,197],"frequent":[91,200],"short":[92,201,209],"episodes).":[93],"Cognitive":[94,105],"assessment":[95],"was":[96,138],"conducted":[97],"using":[98],"Mini-Mental":[100],"State":[101],"Examination":[102],"Montreal":[104],"Assessment":[106],"pre-surgery,":[107],"immediately":[108],"after,":[109],"on":[111,145,299],"day":[113,159],"1.":[114,160],"Results":[115],"results":[117,295],"indicated":[118],"that":[119,229,287],"93.1%":[120],"patients":[122,187,214],"experienced":[123],"defined,":[126],"primarily":[127],"mild":[128],"moderate":[130,189],"cases,":[131],"with":[132,169,180,182,188,194,206,254],"no":[133],"severe":[134],"instances":[135],"recorded.":[136],"ePOCD":[137,184,216,242,255,262,291,327],"identified":[139],"3.1%":[141],"patients.":[143],"Scores":[144],"both":[146],"assessments":[148],"dropped":[149],"significantly":[150,218],"right":[151],"after":[152],"surgery":[153],"showed":[155],"partial":[156],"recovery":[157],"Notably,":[161],"presence":[163],"did":[166],"not":[167,272,282],"correlate":[168],"ePOCD,":[170],"whereas":[171,244],"pattern":[175,249],"were":[178,217,252],"associated":[179,253],"it,":[181],"higher":[183],"rates":[185],"those":[193,205],"single":[196,208],"episode":[198],"or":[199],"episodes":[202],"than":[203],"(controlled)":[210],"episode.":[211],"In":[212],"addition,":[213],"experiencing":[215],"older":[219],"had":[221],"longer":[222],"durations":[223],"hypotension.":[225],"findings":[227],"suggest":[228],"simple":[231],"threshold":[232],">20%":[234],"relative":[235],"change":[236],"MAP":[238],"fails":[239],"predict":[241,290],"risk,":[243],"cumulative":[245],"exposure,":[246],"severity,":[247],"this":[257],"exploratory":[258],"analysis.":[259],"Because":[260],"all":[261],"events":[263,328],"occurred":[264],"oldest":[267],"patients,":[268],"these":[269,288],"associations":[270],"could":[271],"be":[273,283],"separated":[274],"effect":[277],"age":[279,332],"should":[281],"interpreted":[284],"evidence":[286],"measures":[289],"independently.":[292],"Discussion":[293],"These":[294],"argue":[296],"against":[297],"relying":[298],"binary":[300],"neurocognitive":[305],"studies":[306],"highlight":[308],"importance":[310],"exposure":[312],"metrics.":[313],"Confounding,":[314],"particularly":[315],"age,":[317],"prevented":[318],"causal":[319],"inference":[320],"because":[321],"small":[324],"number":[325],"collinearity":[330],"between":[331],"hypotensive":[334],"exposure.":[335]},"counts_by_year":[],"updated_date":"2026-10-31T12:09:11.096373","created_date":"2026-10-29T00:00:00"}
