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Intraoperative Hemodynamic Instability and Higher ASA Classification Increase the Risk of Developing Non-Surgical
Ting-Jui Hsu1, Jen-Yu Chen1, Yu-Ling Wu1
1Department of Orthopedic, Kaohsiung Veterans General Hospital, Kaohsiung 813414, Taiwan.
Journal of Clinical Medicine
|March 28, 2024
Summary
Pre-operative physical status, indicated by American Society of Anesthesiologist (ASA) classification, and intraoperative hemodynamic instability significantly increase non-surgical complications in orthopedic surgery patients. Maintaining hemodynamic stability is crucial for preventing adverse events.
Area of Science:
- Anesthesiology
- Orthopedic Surgery
- Critical Care Medicine
Background:
- Pre-operative patient physical status and intraoperative hemodynamic changes are potential contributors to vital organ dysfunction.
- Orthopedic surgery patients face risks of non-surgical complications, necessitating investigation into contributing factors.
- The American Society of Anesthesiologist (ASA) classification is a key indicator of patient physical status.
Purpose of the Study:
- To investigate the impact of ASA classification on non-surgical complications following orthopedic surgery.
- To determine the association between intraoperative hemodynamic instability and non-surgical complications in orthopedic patients.
- To identify risk factors for vital organ dysfunction after orthopedic procedures.
Main Methods:
- Retrospective analysis of 6478 orthopedic surgery patients (2018-2020).
- Data extraction from anesthesia databases for ASA classification and intraoperative hemodynamic parameters.
- Definition of non-surgical complications as vital organ dysfunction.
Main Results:
- Patients with ASA III/IV classifications had significantly higher odds ratios (17.49 and 40.96, respectively) for non-surgical complications compared to ASA I.
- A 20% reduction in systolic blood pressure (SBP) intraoperatively was associated with non-surgical complications (OR=1.38, p=0.02).
- Prolonged intraoperative hypotension (SBP < 100 mmHg for >20 min) showed an increased risk of postoperative complications (OR=1.33, p=0.34).
Conclusions:
- Higher ASA classifications (III/IV) and extended intraoperative hypotension significantly elevate the risk of adverse events in major organs.
- Maintaining hemodynamic stability during orthopedic surgery is essential for preventing non-surgical complications.
- These findings underscore the importance of vigilant hemodynamic monitoring and management in orthopedic surgery.
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