Persistent Orthostatic Hypotension Following Surgery for Adult Spinal Deformity: Prevalence, Risk Factors, and Cardiovascular Evaluation.

Study Design Retrospective case-control study. Purpose To understand the prevalence of persistent orthostatic hypotension (POH), as well as its risk factors and cardiovascular pathology, in patients receiving surgery for the adult spinal deformity (ASD). Overview of Literature Although reports of the incidence of and risk factors for POH in different spinal disorders have recently been published, we are not aware of the comprehensive evaluation of POH following surgery for ASD. Methods We examined medical records from a single central database for 65 patients receiving surgical treatment for ASD. Statistical comparisons were made between patients who experienced postoperative POH and those who did not, by examining patient and operative characteristics, such as age, sex, comorbidities, functional status, preoperative neurological function, vertebral fractures, three-column osteotomy, total operative time, estimated blood loss, length of stay, and radiographic parameters. The determinants of POH were assessed using multiple logistic regression. Results We showed that postoperative POH was a complication of ASD surgery, with a 9% incidence rate. Patients with POH were statistically considerably more likely to require supported walkers due to partial paralysis and to have comorbidities including diabetes and neurodegenerative disease (ND). Furthermore, ND was an independent risk factor for postoperative POH (odds ratio, 4.073; 95% confidence interval, 1.094-8.362; p =0.020). Moreover, perioperative evaluation of the inferior vena cava showed that patients with postoperative POH had preoperative congestive heart failure and had hypovolemia lower postoperative diameter of the inferior vena cava than patients without POH. Conclusions Postoperative POH is a potential complication of ASD surgery. The most pertinent risk factor is having an ND. According to our study, patients who have surgery for ASD may experience alterations in their hemodynamics.

[1]  C. Lamartina,et al.  Revision surgery in distal junctional kyphosis , 2020, European Spine Journal.

[2]  J. Thompson,et al.  Hemodynamic changes in women with symptoms of supine hypotensive syndrome , 2019, Acta obstetricia et gynecologica Scandinavica.

[3]  Takehiro Michikawa,et al.  Risk, Recovery, and Clinical Impact of Neurological Complications in Adult Spinal Deformity Surgery. , 2019, Spine.

[4]  Arun-Kumar Kaliya-Perumal,et al.  Orthostatic Hypotension Following Cervical Spine Surgery: Prevalence and Risk Factors , 2019, Global spine journal.

[5]  R. Freeman,et al.  Orthostatic Hypotension: JACC State-of-the-Art Review. , 2018, Journal of the American College of Cardiology.

[6]  Symptomatic orthostatic hypotension in Parkinson's disease patients: Prevalence, associated factors and its impact on balance confidence , 2018, Journal of Neurological Sciences.

[7]  R. Kozu,et al.  Incidence of orthostatic hypotension and cardiovascular response to postoperative early mobilization in patients undergoing cardiothoracic and abdominal surgery , 2017, BMC Surgery.

[8]  D. K. Hamilton,et al.  Incidence of perioperative medical complications and mortality among elderly patients undergoing surgery for spinal deformity: analysis of 3519 patients. , 2017, Journal of neurosurgery. Spine.

[9]  K. Xia,et al.  Prediction of orthostatic hypotension in multiple system atrophy and Parkinson disease , 2016, Scientific Reports.

[10]  W. Poewe,et al.  New insights into orthostatic hypotension in multiple system atrophy: a European multicentre cohort study , 2015, Journal of Neurology, Neurosurgery & Psychiatry.

[11]  R. Pfeiffer.  Autonomic dysfunction in Parkinson's disease , 2012, Expert review of neurotherapeutics.

[12]  F. Meyer,et al.  Orthostatic Hypotension Following Resection of a Dorsal Medullary Hemangioblastoma , 2012, Neurocritical Care.

[13]  C. Ames,et al.  Morbidity and mortality after spinal deformity surgery in patients 75 years and older: complications and predictive factors. , 2011, Journal of neurosurgery. Spine.

[14]  K. Bridwell,et al.  Risk-Benefit Assessment of Surgery for Adult Scoliosis: An Analysis Based on Patient Age , 2011, Spine.

[15]  S. Taniuchi,et al.  Two types of orthostatic dysregulation assessed by diameter of inferior vena cava , 2011, Pediatrics international : official journal of the Japan Pediatric Society.

[16]  A. Krassioukov,et al.  A systematic review of the management of orthostatic hypotension after spinal cord injury. , 2009, Archives of physical medicine and rehabilitation.

[17]  Raija Korpelainen,et al.  Orthostatic hypotension, balance and falls in Parkinson's disease , 2009, Movement disorders : official journal of the Movement Disorder Society.

[18]  D. Goldstein,et al.  Neurogenic Orthostatic Hypotension: A Pathophysiological Approach , 2009, Circulation.

[19]  K. Bridwell,et al.  The Impact of Perioperative Complications on Clinical Outcome in Adult Deformity Surgery , 2007, Spine.

[20]  F. Schwab,et al.  Adult Scoliosis: Prevalence, SF-36, and Nutritional Parameters in an Elderly Volunteer Population , 2005, Spine.

[21]  H. Higashino,et al.  Measurement of inferior vena cava diameter for evaluation of venous return in subjects on day 10 of a bed-rest experiment. , 2004, Journal of applied physiology.

[22]  S. Lanni,et al.  Hemodynamic changes and baroreflex gain in the supine hypotensive syndrome. , 2002, American journal of obstetrics and gynecology.

[23]  W. Mckinley,et al.  Comparison Of Medical Complications Following Nontraumatic And Traumatic Spinal Cord Injury , 2002, The journal of spinal cord medicine.

[24]  William J. Pesce,et al.  Circulatory hypokinesis and functional electric stimulation during standing in persons with spinal cord injury. , 2001, Archives of physical medicine and rehabilitation.

[25]  K. Stiller,et al.  The prevalence of orthostatic hypotension during physiotherapy treatment in patients with an acute spinal cord injury , 2000, Spinal Cord.

[26]  O. Rascol,et al.  Prevalence of orthostatic hypotension in Parkinson’s disease , 1997, Journal of neurology, neurosurgery, and psychiatry.

[27]  D. Bild,et al.  Orthostatic hypotension in older adults. The Cardiovascular Health Study. CHS Collaborative Research Group. , 1992, Hypertension.

[28]  B. Wallin,et al.  Sympathetic activity in man after spinal cord injury. Outflow to muscle below the lesion. , 1986, Brain : a journal of neurology.

[29]  A. Weder,et al.  Orthostatic hypotension: a common, serious and underrecognized problem in hospitalized patients. , 2012, Journal of the American Society of Hypertension : JASH.

[30]  P. Huddleston.  Risk-Benefit Assessment of Surgery for Adult Scoliosis: An Analysis Based on Patient Age , 2012 .

[31]  J. D.,et al.  Cardiac autonomic responses to progressive head-up tilt in individuals with paraplegia , 2003, Clinical Autonomic Research.