Time-course of heart rate variability after total hip arthroplasty

Abstract

Purpose Heart rate variability (HRV) is a measure of the autonomic nervous system function and possibly related to postoperative outcome. Despite several HRV studies in different surgical settings, optimal indices and timepoints for measuring have not been adequately determined. Consequently, there is a need for detailed descriptive procedure-specific studies on the time-course of perioperative HRV within a modern fast-track surgical setting. Method We measured HRV continuously in 24 patients from 4 days before until 9 days after total hip arthroplasty (THA). Patients completed the Orthostatic Discriminant and Severity Scale five times during the study, to describe the patient burden potentially related to autonomic nervous system dysfunction. Results Standard deviation between normal-to-normal beats and the total power of HRV were reduced for at least nine days following THA, with a trend towards increased HRV leading up to the day of surgery. The balance between low- and high-frequency power of HRV was reduced in the postoperative evenings. There was increased orthostatic intolerance symptom burden on the first day after surgery, with symptoms of pain, fatigue, and weakness reduced in the postsurgical period. Median hospital stay was 1 day. Conclusion We provide the first detailed description of perioperative time-course of HRV and orthostatic symptoms in fast-track THA, showing reduced HRV after surgery for at least a week, and that HRV changes are sensitive to time of day and timing before and after surgery. These results are helpful in designing future HRV studies in perioperative risk assessment and outcome.