Obesity & hypertension are determinants of poor hemodynamic control during total joint arthroplasty: a retrospective review

Abstract

BackgroundProper blood pressure control during surgical procedures such as total joint arthroplasty (TJA) is considered critical to good outcome. There is poor understanding of the pre-operative risk factors for poor intra-operative hemodynamic control. The purpose of this study is to identify risk factors for poor hemodynamic control during TJA.MethodsWe performed a retrospective cohort analysis of 118 patients receiving TJA in the Dominican Republic. We collected patient demographic and comorbidity data. We developed an a priori definition for poor hemodynamic control: 1) Mean arterial pressure (MAP) <65% of preoperative MAP or 2) MAP >135% of preoperative MAP. We performed bivariate and multivariate analyses to identify risk factors for poor hemodynamic control during TJA.ResultsHypertension was relatively common in our study population (76 of 118 patients). Average preoperative mean arterial pressure was 109.0 (corresponding to an average SBP of 149 and DBP of 89). Forty-nine (41.5%) patients had intraoperative blood pressure readings consistent with poor hemodynamic control. Based on multi-variable analysis preoperative hypertension of any type (RR 2.9; 95% CI 1.3-6.3) and an increase in BMI (RR 1.2 per 5 unit increase; 95% CI 1.0-1.5) were significant risk factors for poor hemodynamic control.ConclusionsPreoperative hypertension and being overweight/obese increase the likelihood of poor blood pressure control during TJA. Hypertensive and/or obese patients warrant further attention and medical optimization prior to TJA. More work is required to elucidate the relationship between these risk factors and overall outcome.

Perioperative morbidity in total knee arthroplasty

“…We found that a poor status of autonomy and general anesthesia were a risk factors of developing intraoperative hypotension. Nwachukwu et al reported that intra operative hypertension and obesity increase the likelihood of poor blood pressure control during TKA [29]…”

Two types of anesthesia and Hemodynamic changes in Patients over 60 years of age who need artificial femoral head replacement: a retrospective cohort study

“…First of all,we found that age,gender,diabetes,heart disease,lung disease,central nervous system disease were not associated with ∆MAP and ∆HR(P>0.05);univariate analysis showed that hypertension were positively correlated with ∆MAP and ∆HR (P<0.05). [12]Then,we found that age,gender,diabetes,hypertension,lung disease,central nervous system disease were not associated with vasopressor (P>0.05);univariate analysis showed that heart disease were positively correlated with vasopressor (P<0.05).…”

Obese patients require higher, but not high pneumatic tourniquet inflation pressures using a novel technique during total knee arthroplasty

“…In our previous studies, we used a CHAMIP technique which provided a bloodless field in all patients with a mean tourniquet pressure of 169.7±7.9 mmHg and 118.2±7.2 mmHg which were significantly lower inflation pressures than reported and recommended in the literature in lower and upper extremity surgeries respectively. [13,14,19] Nwachukwu et al [20] also found that obesity is an independent risk factor for poor hemodynamic control during TKA. In our study, the mean initial systolic blood pressures and the mean intraoperative maximal systolic blood pressures were found to be more elevated in obese group.…”