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Predicting postoperative hypotensive events after posterior spinal fusion for adolescent idiopathic scoliosis
Lawrence L Haber1, Katelyn S Nicholson2, Beejal Shah3
1Department of Pediatric Orthopaedic Surgery, Ochsner Children's Hospital, New Orleans, LA, USA. lawrence.haber@ochsner.org.
Insights
A 4-hour intensive blood pressure monitoring protocol after spinal fusion surgery identified 25% of hypotensive events, showing limited predictive value. Close postoperative monitoring remains crucial for patient safety.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Anesthesiology
Background:
- Hypotension is a primary cause of delayed postoperative neurologic deficit (DPND).
- A 4-hour intensive blood pressure (BP) monitoring protocol was implemented post-posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS).
Purpose of the Study:
- To evaluate the effectiveness of a 4-hour postoperative intensive BP monitoring protocol in predicting hypotensive events (HEs) following PSF for AIS.
Main Methods:
- A case-control study involved 103 AIS patients undergoing PSF with 4-hour intensive BP monitoring.
- Cases experienced at least one HE (MAP < 60), while controls had none.
- Risk factors for HEs were analyzed using t tests and multivariable logistic regression.
Main Results:
- The 4-hour protocol identified 25% of HEs, with 25% sensitivity and 100% specificity.
- Positive predictive value was 100%, and negative predictive value was 88%.
- No patients experienced DPND or neurologic deficits.
Conclusions:
- The 4-hour monitoring protocol has limited predictive capacity for HEs.
- Hypotensive events are challenging to predict, emphasizing the need for vigilant postoperative BP monitoring and rapid intervention.
Purpose:
Hypotension is the most common cause of delayed postoperative neurologic deficit (DPND). Based on previous findings, a 4-h postoperative intensive blood pressure (BP) monitoring protocol was implemented following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). This study aimed to determine the effectiveness of the 4-h postoperative intensive BP monitoring protocol as a predictive tool for identifying postoperative hypotensive events.
Methods:
A case-control study was performed using a prospectively collected dataset of 103 AIS patients who underwent PSF. All patients received 4-h intensive BP monitoring postoperatively before transitioning to standard BP cuff monitoring. Patients who experienced at least one hypotensive event (HE; MAP < 60) were designated as cases, while those with no hypotensive events (NHE) served as controls. Risk factors associated with hypotensive events were then analyzed using t tests and multivariable logistic regression.
Results:
The 4-h postoperative intensive BP monitoring protocol identified 25% of postoperative HEs. The protocol demonstrated a sensitivity of 25%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 88%. Preoperative weight differed significantly between cases and controls (p = 0.02); however, the association did not persist on multivariate analysis. No patients experienced DPND or neurologic deficits.
Conclusion:
The 4-h monitoring protocol identified 25% of HEs, suggesting limited predictive capacity. the protocol demonstrated a sensitivity of 25%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 88%. Hypotensive events remain difficult to predict, illustrating the importance of frequent blood pressure monitoring postoperatively and quick hypotensive response capabilities.
