Steven D Glassman, Leah Y Carreon, Mladen Djurasovic, Desiree Chappell, Wael Saasouh, Christy L Daniels, Colleen H Mahoney, Morgan E Brown, Jeffrey L Gum
{"title":"Intraoperative Hypotension Is an Important Modifiable Risk Factor for Major Complications in Spinal Fusion Surgery.","authors":"Steven D Glassman, Leah Y Carreon, Mladen Djurasovic, Desiree Chappell, Wael Saasouh, Christy L Daniels, Colleen H Mahoney, Morgan E Brown, Jeffrey L Gum","doi":"10.1097/BRS.0000000000005030","DOIUrl":null,"url":null,"abstract":"<p><strong>Study design: </strong>Retrospective observational cohort.</p><p><strong>Objectives: </strong>This study explores the impact of Intraoperative hypotension (IOH) on postoperative complications for major thoracolumbar spine fusion procedures.</p><p><strong>Summary of background data: </strong>IOH with mean arterial pressure (MAP) <65 mm Hg is associated with postoperative acute kidney injury (AKI) in general surgery. In spinal deformity surgery, IOH is a contributing factor to MEP changes and spinal cord dysfunction with deformity correction.</p><p><strong>Methods: </strong>A total of 539 thoracolumbar fusion cases, more than six surgical levels and >3 hours duration, were identified. Anesthetic/surgical data included OR time, fluid volume, blood loss, blood product replacement and use of vasopressors. Arterial-line based MAP data was collected at 1-minute intervals. Cummulative duration of MAP <65 mm Hg was recorded. IOH within the first hour of surgery vs. the entire case was determined. Post-op course and complications including SSI, GI complications, pulmonary complications, MI, DVT, PE, AKI, and encephalopathy were noted. Cumulative complications were grouped as none, one to two complications, or more than three complications.</p><p><strong>Results: </strong>There was a significant association between occurrence of complications and duration of IOH within the first hour of surgery (8.2 vs . 5.6 min, P <0.001) and across the entire procedure (28.1 vs . 19.3 min, P =0.008). This association persisted for individual major complications including SSI, acute respiratory failure, PE, ileus requiring NGT, and postoperative cognitive dysfunction. Comparison of patients with zero versus one to two versus three or more complications demonstrated that patients with three or more complications had a longer duration of IOH in the first hour of the surgery and that patients who had no complications received less vasopressor than patients who had one to two or three or more complications.</p><p><strong>Conclusion: </strong>This study identifies duration of IOH during the first hour of surgery as a previously unrecognized modifiable risk associated with major complications for multilevel lumbar fusion surgery.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"75-80"},"PeriodicalIF":2.6000,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Spine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/BRS.0000000000005030","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/5/8 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Study design: Retrospective observational cohort.
Objectives: This study explores the impact of Intraoperative hypotension (IOH) on postoperative complications for major thoracolumbar spine fusion procedures.
Summary of background data: IOH with mean arterial pressure (MAP) <65 mm Hg is associated with postoperative acute kidney injury (AKI) in general surgery. In spinal deformity surgery, IOH is a contributing factor to MEP changes and spinal cord dysfunction with deformity correction.
Methods: A total of 539 thoracolumbar fusion cases, more than six surgical levels and >3 hours duration, were identified. Anesthetic/surgical data included OR time, fluid volume, blood loss, blood product replacement and use of vasopressors. Arterial-line based MAP data was collected at 1-minute intervals. Cummulative duration of MAP <65 mm Hg was recorded. IOH within the first hour of surgery vs. the entire case was determined. Post-op course and complications including SSI, GI complications, pulmonary complications, MI, DVT, PE, AKI, and encephalopathy were noted. Cumulative complications were grouped as none, one to two complications, or more than three complications.
Results: There was a significant association between occurrence of complications and duration of IOH within the first hour of surgery (8.2 vs . 5.6 min, P <0.001) and across the entire procedure (28.1 vs . 19.3 min, P =0.008). This association persisted for individual major complications including SSI, acute respiratory failure, PE, ileus requiring NGT, and postoperative cognitive dysfunction. Comparison of patients with zero versus one to two versus three or more complications demonstrated that patients with three or more complications had a longer duration of IOH in the first hour of the surgery and that patients who had no complications received less vasopressor than patients who had one to two or three or more complications.
Conclusion: This study identifies duration of IOH during the first hour of surgery as a previously unrecognized modifiable risk associated with major complications for multilevel lumbar fusion surgery.
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Recognized internationally as the leading journal in its field, Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of Spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. The Journal does not publish articles reporting material that has been reported at length elsewhere.
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