Original Article

Journal of Anesthesia

, Volume 27, Issue 6, pp 895-900

First online:

Orthostatic intolerance during early mobilization following video-assisted thoracic surgery

  • Toshiyuki MizotaAffiliated withDepartment of Anesthesia, Kyoto University Hospital Email author 
  • , Yoshika IwataAffiliated withDepartment of Anesthesia, Kyoto University Hospital
  • , Hiroki DaijoAffiliated withDepartment of Anesthesia, Kyoto University Hospital
  • , Tomohiro KoyamaAffiliated withDepartment of Anesthesia, Kyoto University Hospital
  • , Tomoharu TanakaAffiliated withDepartment of Anesthesia, Kyoto University Hospital
  • , Kazuhiko FukudaAffiliated withDepartment of Anesthesia, Kyoto University Hospital

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Abstract

Purpose

Early postoperative mobilization is crucial for early ambulation to reduce postoperative pulmonary complications after lung resection. However, orthostatic intolerance (OI) may delay patient recovery, leading to complications. It is therefore important to understand the prevalence of and predisposing factors for OI following video-assisted thoracic surgery (VATS), which have not been established. This study evaluated the incidence of OI, impact of OI on delayed ambulation, and predisposing factors associated with OI in patients after VATS.

Methods

This retrospective cohort study consecutively analyzed data from 236 patients who underwent VATS. The primary outcome was defined as OI with symptoms associated with ambulatory challenge on postoperative day 1 (POD1), including dizziness, nausea and vomiting, feeling hot, blurred vision, or transient syncope. Multivariate logistic regression was performed to identify independent factors associated with OI.

Results

Of the 236 patients, 35.2 % (83) experienced OI; 45.8 % of these could not ambulate at POD1, compared with 15.7 % of patients without OI (P < 0.001). Factors independently associated with OI included advanced age [odds ratio 2.83 (1.46–5.58); P = 0.002], female gender [odds ratio 2.40 (1.31–4.46); P = 0.004], and postoperative opioid use [odds ratio 2.61 (1.23–5.77); P = 0.012]. Use of thoracic epidural anesthesia was not independently associated with OI [odds ratio 0.72 (0.38–1.37); P = 0.318].

Conclusion

Postoperative OI was common in patients after VATS and significantly associated with delayed ambulation. Advanced age, female gender, and postoperative opioid use were identified as independent predisposing factors for OI.

Keywords

Orthostatic intolerance Video-assisted thoracic surgery Opioids Ambulation Analgesia