Intraoperative hypotension and postoperative neurocognitive impairment in surgical patients with sepsis: A retrospective observational study

Background Postoperative neurocognitive impairment is frequently observed in critically ill surgical patients with sepsis, but its perioperative contributors remain insufficiently defined. This study evaluated the associations of intraoperative hypotension and disease severity—assessed using the Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores—with postoperative neurocognitive impairment and 28-day all-cause mortality in this population. Methods This single-center retrospective observational study included 285 adult patients with sepsis who were admitted to the intensive care unit after surgery. Postoperative neurocognitive impairment was operationally defined as new-onset disturbance of consciousness, attention, orientation, or mental status during the first postoperative intensive care unit stay, after excluding primary central nervous system disease, overt metabolic encephalopathy, and direct sedative or analgesic effects. Univariable and multivariable logistic regression analyses were performed to identify factors associated with postoperative neurocognitive impairment. A secondary analysis was conducted among patients who developed postoperative neurocognitive impairment to explore factors associated with 28-day all-cause mortality. Results Postoperative neurocognitive impairment occurred in 140 of 285 patients (49.1%). In multivariable analysis, older age, longer duration of intraoperative hypotension, greater intraoperative hypotension burden, higher SOFA score, and higher APACHE II score were independently associated with postoperative neurocognitive impairment. Among patients with postoperative neurocognitive impairment, intraoperative hypotension exposure and higher SOFA and APACHE II scores were independently associated with 28-day all-cause mortality. Conclusions Operationally defined postoperative neurocognitive impairment was common in surgical patients with sepsis admitted to the intensive care unit after surgery. Intraoperative hypotension exposure and higher SOFA and APACHE II scores were associated with postoperative neurocognitive impairment and 28-day all-cause mortality, suggesting that perioperative hemodynamic instability may have prognostic relevance in this high-risk population.