A methodological cohort study using the VitalDB database found that intraoperative hypotension exposure shows little incremental value for predicting ICU admission, despite associations with greater resource use. The analysis shows that how anesthetic hypotension is measured—monitoring modality, sampling intervals, exposure duration, and observation windows—substantially changes hypotension classification. The work demonstrated that sparse invasive sampling can undercount hypotension compared with continuous measurement and that expanding observation windows dramatically increases supported hypotension prevalence. Even when the signal correlated with resource use minutes, discrimination for ICU admission remained effectively absent. For clinical teams deploying decision support, the findings underscore that endpoint choice and measurement definitions can dominate model performance more than the underlying physiological association.