Association of Intraoperative Blood Pressure Excursions Below Cerebral Autoregulatory Boundaries With Organ Injury Following Major Noncardiac Surgery

Inclusion Criteria (All patients): * undergoing major noncardiac surgery in general anesthesia will be included. Major noncardiac surgery is defined as: * vascular surgery (with the exception of arteriovenous shunt, vein stripping procedures and carotid endarterectomies) * intraperitoneal surgery * intrathoracic surgery * major orthopedic surgery * at cardiovascular risk, defined as meeting at least 1 of the following 6 criteria: * preoperative NT-proBNP ≥ 200 ng/l * history of coronary artery disease * history of peripheral vascular disease * history of stroke * undergoing major vascular surgery, with the exception of arteriovenous shunt, vein stripping procedures and carotid endarterectomies * fulfillment of any 3 of the 8 following criteria: * undergoing major surgery (intrathoracic, intraperitoneal or suprainguinal vascular surgery) * any history of CHF or history of pulmonary edema * anamnestic transient ischemic attack (TIA) * diabetes under treatment with either oral antidiabetic agent or insulin * age \> 70 years * history of hypertension * serum creatinine \> 175 mcmol/l or calculated creatinine clearance \< 60 l/min/1.73m2 (Cockroft Gault) * history of smoking within 2 years of surgery * intraoperative continuous invasive blood pressure monitoring indicated due to anesthetic or surgical factors * planned surgical time ≥ 90 minutes * planned postoperative hospital stay at least 1 night Additional inclusion criteria for neurologic injury sub-study: * Age ≥ 65 years Exclusion Criteria (All patients): * pregnancy (anamnestic) * emergent surgery * urological surgery * renal insufficiency with creatinine clearance \< 30 ml/min (Cockroft- Gault equation) or on dialysis * inclusion in an interventional clinical trial with any common endpoints: acute kidney injury, perioperative myocardial injury, components of the composite major cardiovascular, renal and neurological complications up to 1 year following surgery (ACS, CHF, coronary revascularization, stroke, new CKD or progression of CKD, new need for renal replacement therapy, mortality), neurological injury, delirium, exception: potential inclusion of subset of patients in RCT investigating the perioperative use of colchicine in major noncardiac surgery (COLCAT study). * previously enrolled in this study