Impact of Predictive Hemodynamic Monitoring on Intra-operative Hypotension and Postoperative Complications in Multi-level Spinal Fusion Surgery

 

Wael Saasouh, MD^1,2, Steven D. Glassman MD³, Leah Y. Carreon MD, MSc³, Desiree Chappell, MSNA, CRNA, FAAN¹, Steven Garvin, CRNA¹, Anna M. Lavelle, MSN, CRNA¹, Jeffrey L. Gum, MD³, Mladen Djurasovic MD³

 

¹ NorthStar Anesthesia, 6225 State Hwy 161 #200, Irving, TX, 75038 USA

² Outcomes Research Consortium, Cleveland Clinic, 9500 Euclid Ave, L1-407, Cleveland, OH 44195

³ Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40202

 

Background context: Prior studies report that intraoperative hypotension over 15 cumulative minutes increases the risk of complications in non-cardiac surgeries^1-3. However, the occurrence of intraoperative hypotension as a modifiable risk factor for complications and prolonged hospital stay has not been widely studied.

Purpose: To determine if the use of Artificial Intelligence enabled predictive hemodynamic monitoring (PHM) decreases episodes of intra-operative hypotension during elective multi-level posterior instrumented spine fusions and if PHM is associated with a decrease in complications

Study design: Prospective longitudinal comparative cohort

Patient sample: Adult undergoing elective multi-level posterior thoracolumbar fusion with arterial line blood pressure monitoring.

Outcome measures: MAP per minute, post-operative complications

Methods: Patients where PHM was used and a similar set of patients in whom PHM was not used (Non-PHM) were identified. The number of minutes of hypotension (MAP<65mmHg) and hypertension (MAP≥100mmHg), volume of fluids, blood products and vasopressors administered intra-operatively, urine output, volume of fluids and blood products administered within the first 4 hours post-operative and the number and type of post-operative complications were also collected.

Results: The 47 cases in the PHM group and 70 in the Non-PHM group were comparable in terms of demographic and operative variables. A shorter duration of intra-operative hypotension was seen in the PHM group (8.13 mins) compared to the Non-PHM group (13.28 mins, p=0.029); and a shorter duration of intra-operative hypertension seen in the PHM group (0.46 mins, range, 0-5 mins) compared to the Non-PHM group (1.38 mins, range 0 to 17 mins, p=0.032).

There was a smaller number of patients in the PHM group who had a surgical site infection (2.% vs 13%, p=0.027), post-operative nausea and vomiting (0 vs 14%, p=0.004) and post-operative cognitive dysfunction (6% vs 19%, p=0.049) compared to the Non-PHM group. There was also a statistically significant shorter length of hospital stay in the PHM (4.62 days) compared to the Non-PHM group (5.99 days, p=0.017)

Conclusion: The use of predictive hemodynamic monitoring to manage intraoperative hemodynamic instability is associated with a shorter duration of intra-operative hypotension and hypertension, lower prevalence of complications and decreased length of stay in multi-level spinal fusion surgery.

 

References

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2. Maheshwari K, Ahuja S, Khanna AK, Mao G, Perez-Protto S, Farag E, Turan A, Kurz A, Sessler DI.Association Between Perioperative Hypotension and Delirium in Postoperative Critically Ill Patients: A Retrospective Cohort Analysis.Anesth Analg. 2020 Mar;130(3):636-643. doi: 10.1213/ANE.0000000000004517.
3. Salmasi V, Maheshwari K, Yang D, Mascha EJ, Singh A, Sessler DI, Kurz A.Relationship between Intraoperative Hypotension, Defined by Either Reduction from Baseline or Absolute Thresholds, and Acute Kidney and Myocardial Injury after Noncardiac Surgery: A Retrospective Cohort Analysis.Anesthesiology. 2017 Jan;126(1):47-65.