Vasoplegia Following Complex Spine Surgery: Incidence and Risk

Area of Science:

• Neurosurgery
• Anesthesiology
• Critical Care Medicine

Background:

• Vasoplegia, a severe form of distributive shock, is characterized by low systemic vascular resistance and hypotension.
• This condition has not been previously described in the context of complex spine surgery.
• Understanding vasoplegia in this surgical population is crucial for managing morbidity and mortality.

Purpose of the Study:

• To determine the incidence of vasoplegia in patients undergoing complex multi-level thoraco-lumbar spine surgery.
• To identify risk factors, complications, and postoperative outcomes associated with vasoplegia in this patient group.
• To describe the clinical presentation and management of vasoplegia following extensive spinal procedures.

Main Methods:

• Retrospective cohort study analyzing electronic medical records from January 2014 to June 2018.
• Inclusion criteria: patients undergoing multi-level ( >6 levels) thoraco-lumbar spine surgery.
• Data collected included demographics, surgical details, hypotension events, vasoplegia diagnosis, complications, and outcomes with a minimum 3-month follow-up.

Main Results:

• Out of 994 patients who underwent multi-level thoraco-lumbar spine surgery, 5 patients (0.6% incidence) were diagnosed with vasoplegia after excluding other causes of hypotension.
• Identified risk factors for vasoplegia included prolonged surgery duration and osteotomies.
• No significant impact on neurological outcome was observed; one major and three minor complications occurred, with all patients achieving full recovery.

Conclusions:

• Vasoplegia is a rare complication following complex multi-level thoraco-lumbar spine surgery with an incidence of 0.6%.
• Patients experiencing vasoplegia in this cohort did not have worse surgical outcomes or neurological deficits.
• Consideration of specialized intraoperative hemodynamic monitoring is recommended for high-risk patients undergoing extensive spine surgery.