Association between cumulative intraoperative hypotension and postoperative ICU admission after gastrointestinal lumen cancer surgery: a retrospective cohort study using the INSPIRE database.

Background: Intraoperative hypotension is associated with postoperative organ injury, but its relationship with postoperative intensive care unit (ICU) admission after gastrointestinal lumen cancer surgery remains uncertain. Methods: We conducted a retrospective cohort study using the INSPIRE perioperative database. Adults undergoing their first gastrointestinal lumen excision or resection, identified by ICD-10-PCS 0DB*/0DT* codes and a temporally aligned ICD-10-CM C15-C21 diagnosis, were included. The primary exposure was cumulative duration of mean arterial pressure (MAP) <65 mmHg, categorized as 0, >0 to <10, 10 to <30, and ≥30 min. Multivariable logistic regression adjusted for demographic, clinical, laboratory, and surgical factors. Secondary analyses characterized the empirical MAP measurement intervals, time-weighted area below MAP 65 mmHg, and hypotension burden normalized to the monitored, strict operation, and strict anesthesia windows. Results: Among 7,405 patients, 1,157 (15.62%) were admitted to the ICU. ICU admission rates were 7.15, 10.91, 15.25, and 32.01% across increasing exposure categories. In the complete-case expanded model ( Conclusion: Sustained intraoperative MAP <65 mmHg, particularly for ≥30 min, was associated with higher odds of postoperative ICU admission after adjustment for measured clinical and surgical factors. Findings remained consistent when hypotension depth and time-normalized burden were considered, but do not establish causality or an intervention threshold.