Menu
A 78-year-old man with osteoarthritis requires a total hip arthroplasty. During preoperative assessment, your colleague recommends remote ischemic preconditioning for organ protection. According to a recent meta-analysis that compared remote ischemic preconditioning to control in elective noncardiac surgery, which of the following outcomes will MOST likely be reduced if you perform remote ischemic preconditioning in this patient?
(A) All-cause mortality ✔
(B) Renal replacement therapy X
(C) Myocardial injury X
Gain insight on this topic, and many others, with Summaries of Emerging Evidence (SEE) 2026 – Volume 42B, now available. The content is aggregated from 30 international medical journals to streamline your learning and improve your practice.
Remote ischemic preconditioning is an affordable technique during which a cuff is placed on an upper or lower limb and is inflated and deflated to promote brief episodes of limb ischemia. The limb releases mediators into the bloodstream during ischemia to promote a protective effect against subsequent ischemic insults on the affected limb as well as other organs including the heart and kidneys. Some study data have found that remote ischemic preconditioning can decrease myocardial and renal injuries, but most studies have been underpowered.
Recently, a meta-analysis was performed to examine the clinical outcomes of remote ischemic preconditioning in adult patients undergoing elective noncardiac surgery. Of 3,973 studies identified, the final analysis included 72 randomized controlled trials (7,457 patients), and all but 1 were published in peer-reviewed journals. In 44 studies, remote ischemic preconditioning was performed by placing the cuff on an upper limb, whereas in 22 studies, a lower limb was used. The remaining studies used various methods and limbs. A remote ischemic preconditioning strategy of 5 minutes of inflation and 5 minutes of deflation for 3 or 4 cycles was used by most studies.
The primary outcome of this study was all-cause mortality at the longest available follow-up. Secondary outcomes were cardiac complications, including peak postoperative troponin levels, myocardial injury and infarction, congestive heart failure, and arrythmias; renal injury, including peak postoperative creatinine level, acute kidney injury, and renal replacement therapy; stroke; and hospital length of stay.
Compared with controls, all-cause mortality was reduced in the remote ischemic preconditioning group (102 of 1,767 patients [5.8%] vs 88 of 2,122 patients [4.1%], respectively; risk ratio [RR], 0.74; 95% CI, 0.57–0.98; number needed to treat, n = 67). In addition, stroke risk was reduced in the remote ischemic preconditioning group compared with the control group (RR, 0.46; 95% CI, 0.24–0.87). The authors also found a small reduction, although the certainty was low, in the length of hospital stay in the remote ischemic preconditioning group compared with the control group (mean difference, –0.8 days; 95% CI, –0.26 to –0.34). Although a reduction in peak postoperative serum creatinine was observed (mean difference, –5.45; 95% CI, –8.09 to –2.81), it was determined to be of low certainty. In addition, no differences were found in the rates of other renal injury markers such as acute kidney injury and renal replacement therapy. The authors found no difference in cardiac complications, including myocardial injury, between the remote ischemic preconditioning and control groups.
In summary, this recent meta-analysis showed that remote ischemic preconditioning prior to elective noncardiac surgery resulted in a reduction in all-cause mortality. The authors found reductions in stroke risk, length of hospital stay, and peak postoperative serum creatinine; however, these results were mostly of low certainty. Other outcomes such as cardiac complications, acute kidney injury, and renal replacement therapy were not found to be different between groups.
Reference
Date of last update: June 26, 2026
You do not have to make a payment at this time, but you can reach out to your practice/group leader to find out when they plan to pay your dues. Email or call the ASA Support team for assistance: (630) 912-2552 or [email protected].
