Blue Rachel, Gutierrez Alexis, Ahmad Hasan S, Alexis Maya, Kumar Rachit, Spadola Michael, Wathen Connor, Weinstein Mitchell, Petrov Dmitriy
Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Int J Spine Surg. 2022 Dec;16(6):1061-1067. doi: 10.14444/8367.
Intraoperative hypotension (IOH) has been found to be associated with organ damage, including cardiac injury and acute kidney injury (AKI). However, to our knowledge, this relationship has not been studied in a neurosurgery-specific patient population. In this report, we review our institutional experience to understand the magnitude of association between IOH in spinal fusion operations and incidence of postoperative AKI.
This retrospective cohort study included 910 patients who underwent posterior spinal fusion procedures performed in the prone position. Intraoperative variables collected and analyzed include minute-by-minute mean arterial pressure (MAP) from an arterial catheter, intermittent blood pressure cuff readings, volume of administered intravenous fluids, urine output, and all relevant vitals and administered medications. The electronic medical record was queried for additional patient data. IOH was defined as MAP <65 mm Hg for greater than 10 minutes. The primary endpoints of the study were presence and staging of AKI ( [Kidney Disease: Improving Global Outcomes] consensus classification), postoperative ileus, and postoperative troponin leak.
Using a partial correlation analysis, no association was found between IOH metrics (IOH occurrence, IOH duration >10 minutes, and total IOH time) and any outcome metrics, including AKI, except for vasopressor usage and estimated blood loss. Patient age at surgery was not associated with any outcome variables. The lack of association between IOH and AKI contrasts with existing literature; this could be due to underlying differences in our patient population or could highlight a more complex relationship between IOH and AKI than previously understood.
Occurrence and duration of IOH were not associated with AKI, postoperative ileus, troponin leak, length of stay, or any other major outcome variables in spinal fusion patients.
These findings depart from previous literature showing a correlation between IOH and AKI and provide level 3 evidence clinically relevant to spinal surgery. Further research is needed to better understand the exact nature of this relationship.
术中低血压（IOH）已被发现与器官损伤有关，包括心脏损伤和急性肾损伤（AKI）。然而，据我们所知，这种关系尚未在神经外科特定患者群体中进行研究。在本报告中，我们回顾了我们机构的经验，以了解脊柱融合手术中IOH与术后AKI发生率之间的关联程度。
这项回顾性队列研究纳入了910例行俯卧位后路脊柱融合手术的患者。收集并分析的术中变量包括来自动脉导管的每分钟平均动脉压（MAP）、间歇性血压袖带读数、静脉输液量、尿量以及所有相关生命体征和使用的药物。查询电子病历以获取更多患者数据。IOH定义为MAP<65mmHg持续超过10分钟。该研究的主要终点是AKI的存在和分期（[改善全球肾脏病预后组织]共识分类）、术后肠梗阻和术后肌钙蛋白泄漏。
使用偏相关分析，未发现IOH指标（IOH发生、IOH持续时间>10分钟和总IOH时间）与任何结局指标之间存在关联，包括AKI，但血管升压药使用和估计失血量除外。手术时患者年龄与任何结局变量均无关联。IOH与AKI之间缺乏关联与现有文献形成对比；这可能是由于我们患者群体的潜在差异，或者可能突出了IOH与AKI之间比以前理解的更复杂的关系。
IOH的发生和持续时间与脊柱融合患者的AKI、术后肠梗阻、肌钙蛋白泄漏、住院时间或任何其他主要结局变量均无关联。
这些发现与先前显示IOH与AKI之间存在相关性的文献不同，并提供了与脊柱手术临床相关的3级证据。需要进一步研究以更好地理解这种关系的确切性质。
