The Association Between Fluid Management and Intraoperative Blood Pressure and Patients' Outcome After Complex Spine...

Area of Science:

• Anesthesiology and Perioperative Medicine
• Surgical Outcomes Research
• Critical Care Medicine

Background:

• Intraoperative hypotension and excessive fluid administration are linked to adverse perioperative outcomes.
• The precise thresholds for excessive fluid and the impact of hypotension on major postoperative complications remain areas of investigation.

Purpose of the Study:

• To investigate the relationship between intraoperative net fluid administration and hypotension with major postoperative complications in patients undergoing complex spine surgery.
• To identify a potential change point in fluid administration associated with increased complication risk.

Main Methods:

• A single-center retrospective cohort study included 6243 patients undergoing complex spine surgery between 2012 and 2022.
• The study analyzed the association between intraoperative net fluid administration and hypotension with a composite of major postoperative complications (AKI, MI, stroke, ICU admission), as well as secondary outcomes like pulmonary complications, SSI, and mortality.

Main Results:

• A change point for net fluid administration was identified at 1865 mL. Fluid administration above this threshold was associated with a 1.16-fold increased odds of postoperative complications (P < .0001).
• Every 500 mL increase in net fluid administration above the change point increased complication odds (OR 1.16), while below it, odds decreased (OR 0.87).
• Intraoperative hypotension occurred in 29% of cases and was associated with a 1.57-fold increased odds of any postoperative complication (P < .0001).

Conclusions:

• A net fluid administration threshold of 1865 mL was identified, with higher volumes increasing the risk of postoperative complications.
• Intraoperative hypotension is a significant risk factor for increased postoperative complications following complex spine surgery.
• These findings underscore the importance of optimizing fluid management and monitoring for hypotension during complex spine procedures to mitigate adverse outcomes.