Intraoperative hypotension in non-emergency decompression surgery for cervical spondylosis: The role of chronic arterial hypertension

Abstract

BackgroundCervical spondylotic myelopathy and chronic hypertension show a cause-effect relationship. Hypertension increases cardiovascular risk and is associated with intraoperative hypotension. We aimed to evaluate intraoperative hypotension in patients undergoing non-emergency decompression surgery for cervical spondylosis and its association with clinical myelopathy and chronic arterial hypertension.MethodsThis retrospective cohort study used healthcare data of adult patients undergoing cervical spine surgeries at Taipei Veterans General Hospital from 2015 to 2019. The primary outcomes were the incidence of intraoperative hypotension and predictive factors, and the secondary outcomes were the association of intraoperative hypotension and postoperative adverse outcomes in the surgical population.ResultsAmong the 1833 patients analyzed, 795 (43.4%) required vasopressor treatment and 342 (18.7%) showed persistent hypotension. Factors independent associated with hypotension after anesthetic induction were age [odds ratio (OR), 1.15; 95% confidence interval (CI), 1.07-1.23 per 5 years, P < 0.001], male sex (OR, 1.63; 95% CI, 1.21-2.19, P < 0.001), chronic hypertension (OR, 1.77; 95% CI, 1.32-2.38, P < 0.001), upper cervical spine level C0-2 treated (OR, 3.04; 95% CI, 1.92-4.84, P < 0.001 vs. C3-T1), and increased number of spine segments treated (OR, 1.43; 95% CI 1.26-1.63, P < 0.001). Patients who developed intraoperative hypotension experienced more acute postoperative kidney injury (OR, 7.90; 95% CI, 2.34–26.63, P < 0.001), greater need for intensive care (OR, 1.80; 95% CI, 1.24–2.60, P = 0.002), and longer admission after surgery (1.09 days longer, 95% CI 0.06-2.12, P = 0.038).ConclusionIntraoperative hypotension is common even in non-emergency cervical spine surgery. A history of hypertension independently predicted intraoperative hypotension. Prompt assessments for identifiable features can help ameliorate intraoperative hypotension.

Incidence of Complications in Obese Patients Undergoing Elective Spine Surgery Under General Anesthesia: A Retrospective Study

“…16 17 In a retrospective analysis of cervical spine surgery for cervical spondylosis, Chiang et al reported 43.4% incidence of intraoperative hypotension and was associated more in older patients, male sex, chronic hypertension, and increased number of spine segment treated. 18 The incidence of intraoperative hypotension in the current study was lower (26.7%) from that reported by Chiang et al It may be due to the fact that the level of surgery was not restricted to cervical spine only and the pathologies also varied. The hypothesized etiologies are overdosage of the induction agent (when calculated according to the lean body weight) and the unique physiological changes in the cardiovascular system of patients with obesity contributing to cardiomyopathy (e.g., hypervolemic state with venous hypertension, myocardial hypertrophy, diastolic dysfunction, and biventricular dilatation) along with preexisting preoperative dehydration.…”

Effect of Remimazolam- versus Propofol-Based Total Intravenous General Anesthesia on Intraoperative Hemodynamic Stability for Major Spine Surgery in the Prone Position: A Randomized Controlled Trial

“…Third, despite random allocation of patients, differences were observed in terms of weight and the number of patients with diabetes mellitus. However, the differences in weight were not clinically significant, and it is unlikely that the presence of diabetes had a decisive impact on the results of our study [ 31 ].…”

Risk factors associated with intraoperative persistent hypotension in pancreaticoduodenectomy

“…Our study confirms findings from previous studies, which indicated a close relationship of prolonged surgery and increased blood loss to intraoperative hypotension[ 4 , 16 , 17 ]. The risk of intraoperative hypotension escalates with age, especially in older patients, likely attributable to diminished cardiac function, reduced vascular elasticity from atherosclerosis, and decreased sympathetic nerve sensitivity, which impair blood pressure regulation[ 18 - 20 ]. Extended surgery and significant blood loss are indicative of substantial surgical trauma, resulting in prolonged anesthesia exposure and alterations in internal homeostasis[ 21 ].…”