Intra-Operative Hypotension is an Important Modifiable Risk Factor for Major Complications in Spinal Fusion Surgery

Steven D Glassman; Leah Y Carreon; Mladen Djurasovic; Desiree Chappell; Wael Saasouh; Christy Daniels; Colleen Mahoney; Morgan Brown; Jeffrey Gum

doi:10.1097/BRS.0000000000005030

Intra-Operative Hypotension is an Important Modifiable Risk Factor for Major Complications in Spinal Fusion Surgery

Spine (Phila Pa 1976). 2024 May 8. doi: 10.1097/BRS.0000000000005030. Online ahead of print.

Authors

Steven D Glassman¹, Leah Y Carreon¹, Mladen Djurasovic¹, Desiree Chappell², Wael Saasouh^{2

3}, Christy Daniels¹, Colleen Mahoney¹, Morgan Brown¹, Jeffrey Gum¹

Affiliations

¹ Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40202.
² NorthStar Anesthesia, 6225 State Hwy 161 #200, Irving, TX, 75038 USA.
³ Outcomes Research Consortium, Cleveland Clinic, 9500 Euclid Ave, L1-407, Cleveland, OH 44195.

PMID: 38717322
DOI: 10.1097/BRS.0000000000005030

Abstract

Study design: Retrospective observational cohort.

Objectives: This study explores the impact of Intraoperative hypotension (IOH)on post-op complications for major thoracolumbar spine fusion procedures.

Summary of background data: IOH with mean arterial pressure (MAP) < 65 mmHg is associated with post-op 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: 539 thoracolumbar fusion cases, > 6 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 min intervals. Cummulative duration of MAP < 65 mmHg 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, 1-2 complications, or >3 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 post-operative cognitive dysfunction. Comparison of patients with 0 vs. 1-2 vs. 3 or more complications demonstrated that patients with 3 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 1-2 or 3 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 multi-level lumbar fusion surgery.