Spine Surgeon Norton Leatherman Spine Center Los Angeles, California, United States
Disclosure(s):
Jeffrey L. Gum, MD: No relevant disclosure to display
Introduction: IOH with mean arterial pressure (MAP) < 65mmHg is associated with post-op complications in patients undergoing multi-level spine fusions. The impact of persistent hypotension in the immediate post-operative hypotension (iPOH) on the incidence of complications has not been evaluated.
Methods: 539 thoracolumbar fusion cases, > 6 surgical levels and > 3 hours duration were identified. Data included OR time, fluid volume, blood loss, blood product replacement and use of vasopressors. MAP data was collected at 1 min intervals during the surgery and in the first four hours in the recovery room. Patients were stratified into those who had neither IOH or iPOH, had IOH but no iPOH, No IOH but had iPOH and had both IOH and iPOH.
Results: There was no difference in demographic parameters such as age, sex, BMI, and ASA score. IOH and iPOH had a cumulative effect on the incidence of complications with the lowest in patients with no IOH and no iPOH (21%) and highest in those with both IOH and iPOH (44%, p=0.006). Post-op transfusion, colloid volume, and Norepinephrine requirements were also significantly increased in groups with either IOH or iPOH. A longer hospital stay and a greater proportion of patients who had a non-home discharge was seen in those who had iPOH.
Conclusion : Duration of hypotension during surgery (IOH) and immediately after in the recovery room (iPOH) has a cumulative impact on number of complications following thoracolumbar fusion. Understanding the appropriate prevention and treatment strategy can impact complications, LOS, and disposition. This unrecognized modifiable risk extends beyond protecting the spinal cord and offers an important opportunity to increase safety and improve clinical outcomes.