Role of heart-rate variability in preoperative assessment of physiological reserves in patients undergoing major abdominal surgery

Abstract

BackgroundMajor abdominal surgery (MAS) is associated with increased morbidity and mortality. The main objective of our study was to evaluate the predictive value of heart-rate variability (HRV) concerning development of postoperative complications in patients undergoing MAS. The secondary objectives were to identify the relationship of HRV and use of vasoactive drugs during anesthesia, intensive care unit length of stay (ICU-LOS), and hospital length of stay (H-LOS).Patients and methodsSixty-five patients scheduled for elective MAS were enrolled in a prospective, single-center, observational study. HRV was measured by spectral analysis (SA) preoperatively during orthostatic load. Patients were divided according to cardiac autonomic reactivity (CAR; n=23) and non-cardiac autonomic reactivity (NCAR; n=30).ResultsThe final analysis included 53 patients. No significant difference was observed between the two groups regarding type of surgery, use of minimally invasive techniques or epidural catheter, duration of surgery and anesthesia, or the amount of fluid administered intraoperatively. The NCAR group had significantly greater intraoperative blood loss than the CAR group (541.7±541.9 mL vs 269.6±174.3 mL, p<0.05). In the NCAR group, vasoactive drugs were used during anesthesia more frequently (n=21 vs n=4; p<0.001), and more patients had at least one postoperative complication compared to the CAR group (n=19 vs n=4; p<0.01). Furthermore, the NCAR group had more serious complications (Clavien–Dindo ≥ Grade III n=6 vs n=0; p<0.05) and a greater number of complications than the CAR group (n=57 vs n=5; p<0.001). Significant differences were found for two specific subgroups of complications: hypotension requiring vasoactive drugs (NCAR: n=10 vs CAR: n=0; p<0.01) and ileus (NCAR: n=11 vs CAR: n=2; p<0.05). Moreover, significant differences were found in the ICU-LOS (NCAR: 5.7±3.5 days vs CAR: 2.6±0.7 days; p<0.0001) and H-LOS (NCAR: 12.2±5.6 days vs CAR: 7.2±1.7 days; p<0.0001).ConclusionPreoperative HRV assessment during orthostatic load is objective and useful for identifying patients with low autonomic physiological reserves and high risk of poor post-operative course.

Is pre-operative heart rate variability a prognostic indicator for overall survival and cancer recurrence in patients with primary colorectal cancer?

“…Besides the proposed influence of low HRV on survival of colorectal cancer patients through development and increased progression of cancer, Reimer et al suggested that low HRV could influence survival of those undergoing surgical treatment due to more-and more severe post-operative complications [15]. However, the results found in this study were not concurrent with those of Reimer et al who included 53 patients with ASA > 1 undergoing elective surgery.…”

“…In patients undergoing curative treatment for colorectal cancer, HRV does not only seem to influence cancer prognosis. A recent study showed that patients with lower HRV have more intraoperative blood loss and more, and more severe, postoperative complications [15].…”

Taking Control of Your Surgery: Impact of a Prehabilitation Program on Major Abdominal Surgery

“…Patients who have diminished physiologic reserve are less able to respond to stressors, which translates to less variability in parameters such as blood pressure and heart rate. 29 For example, lower preoperative heart rate variability has been associated with greater risk of hypotension following anesthesia induction, as well as postoperative cardiac events. 30,31 While patients who underwent prehabilitation did have non-significantly increased heart rate variability, they demonstrated significantly increased variability in blood pressure, with an overall increase in systolic and diastolic blood pressure an hour into surgery compared to both other groups.…”

Dynamics of Vagal Activity Due to Surgery and Subsequent Rehabilitation

“…We suggest that in order to reduce the chances of inflammatory conditions in the wake of surgery, it might be worthwhile to provide some activities that increase the vagal activity prior to the surgery (“pre-habilitation”). This would increase the patient’s vagal inflammatory resistance allowing him/her to cope with the event of surgery and the associated stress more effectively (Geiss et al, 2005; Laitio et al, 2007; Mazzeo et al, 2011; Bravi et al, 2012; Bohanon et al, 2015; Ernst et al, 2017; Reimer et al, 2017; Yang et al, 2018). An additional argument in favor of this conclusion comes from our observation that patients with strong pre-surgery values make the best use of the rehabilitation in improving their vagal activity.…”