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Impact of intraoperative hypotension on hospital stay in major abdominal surgery

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Abstract

Purpose

Although the relationship between preoperative risk factors and outcomes has been extensively studied, the effect of intraoperative hemodynamic changes in a patient’s postoperative course has been less well defined.

Methods

We designed a prospective observational study to assess the impact of several variables, and especially hypotension, on postoperative outcome. Patients considered eligible for the study, all more than 18 years old, were mentally stable patients scheduled for major abdominal surgery with an expected duration of more than 2 h. Total hypotension time (THT), with other variables that possibly influence the outcome, was analyzed using multivariate logistic regression analysis in 100 consecutive patients.

Results

Total hypotension time was isolated as a factor significantly associated with morbidity [odds ratio, 5.1 (1.95–13.35)] and significantly prolonged hospital stay [odds ratio, 4.56 (1.85–10.96)]. Patients who had prolonged THT presented more complications (50 vs. 30), especially of the cardiovascular, pulmonary, and gastrointestinal systems. These complications led to delayed hospital discharge in a significant number of patients (36 with THT vs. 17 others). Finally, duration of surgery was associated with postoperative complications [odds ratio, 3.1 (1.2–8.0)].

Conclusion

Persistent hypotension during elective major abdominal surgery is a significant risk factor for postoperative complications and may prolong hospitalization and affect patient outcomes. Anesthetic management for the avoidance of hypotension, as much as possible, during major abdominal surgery may positively affect outcomes.

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References

  1. Fleisher LA, Anderson GF. Perioperative risk: how can we study the influence of provider characteristics? Anesthesiology. 2002;96:1039–41.

    Article  PubMed  Google Scholar 

  2. Monk T, Saini V, Weldon B, Sigl JC. Anesthetic management and one-year mortality after non-cardiac surgery. Anesth Analg. 2005;100:4–10.

    Article  PubMed  Google Scholar 

  3. Charlson ME, Pompei P, Ales KL, Mackenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies development and validation. J Chron Dis. 1987;40:373–83.

    Article  PubMed  CAS  Google Scholar 

  4. Jin F, Chung F. Minimizing perioperative adverse events in the elderly. Br J Anaesth. 2001;87:608–24.

    Article  PubMed  CAS  Google Scholar 

  5. Fasting S, Gisvold SE. Serious intraoperative problems: a five year review of 83,844 anesthetics. Can J Anaesth. 2002;49:545–53.

    Article  PubMed  Google Scholar 

  6. Fowkes FG, Lunn JN, Farrow SC, Robertson IB, Samuel P. Epidemiology in anaesthesia. III. Mortality risk in patients with coexisting physical disease. Br J Anaesth. 1982;54:819–25.

    Article  PubMed  CAS  Google Scholar 

  7. Hallan S, Molaug PO, Arnulf V, Gisvold SE. Causes and risk factors of intraoperative anesthesia complications. A prospective study of 14,735 anaesthesias. Tidsskr Nor Laegeforen. 1990;110:38–41.

    PubMed  CAS  Google Scholar 

  8. Sigurdsson GH, McAteer E. Morbidity and mortality associated with anaesthesia. Acta Anaesthesiol Scand. 1996;40:1057–63.

    PubMed  CAS  Google Scholar 

  9. Arbous MS, Grobbee DE, van Kleef JW, de Lange JJ, Spoormans HH, Touw P, Werner FM, Meursing AE. Mortality associated with anaesthesia: a qualitative analysis to identify risk factors. Anaesthesia. 2001;56:1141–53.

    Article  PubMed  CAS  Google Scholar 

  10. Reich DL, Bennett-Guerrero E, Bodian CA, Hossain S, Winfree W, Krol M. Intraoperative tachycardia and hypertension are independently associated with adverse outcome in non-cardiac surgery of long duration. Anesth Analg. 2002;95:273–7.

    PubMed  Google Scholar 

  11. Nortcliffe SA, Buggy DJ. Implications of anesthesia for infection and wound healing. Int Anesthesiol Clin. 1992;41:201–20.

    Google Scholar 

  12. Badner NH, Knill RL, Brown JE, Novick TV, Gelb AW. Myocardial infarction after noncardiac surgery. Anesthesiology. 1998;88:572–8.

    Article  PubMed  CAS  Google Scholar 

  13. Reich DL, Wood RK Jr, Emre S, Bodian CA, Hossain S, Krol M, Feirman D. Association of intraoperative hypotension and pulmonary hypertension with adverse outcomes after orthotopic liver transplantation. J Cardiothorac Vasc Anesth. 2003;17:699–702.

    Article  PubMed  Google Scholar 

  14. Charlson ME, MacKenzie CR, Gold JP, Ales KL, Topkins M, Fairclough GP Jr, Shires GT. The preoperative and intraoperative hemodynamic predictors of postoperative myocardial infarction or ischemia in patients undergoing noncardiac surgery. Ann Surg. 1989;210:637–48.

    Article  PubMed  CAS  Google Scholar 

  15. Jain U, Laflamme CJ, Aggarwal A, Ramsay JG, Comunale ME, Ghoshal S, Ngo L, Ziola K, Hollemberg M, Mangano DT. Electrocardiographic and hemodynamic changes and their association with myocardial infarction during coronary artery bypass surgery. Anesthesiology. 1997;86:576–91.

    Article  PubMed  CAS  Google Scholar 

  16. Williams-Russo P, Sharrock NE, Mattis S, Liguori GA, Mancuso C, Peterson MG, Hollenberg J, Ranawat C, Salvati E, Sculco T (1999) Randomized trial of hypotensive epidural anesthesia in older persons. Anaesthesiology. 91:926–35.

    Google Scholar 

  17. Charlson ME, Mackenzie CR, Gold JP, Ales KM, Topkins M, Shires GT. Preoperative characteristics predicting intraoperative hypotension and hypertension among hypertensives and diabetics undergoing non cardiac surgery. Ann Surg. 1990;212:66–81.

    Article  PubMed  CAS  Google Scholar 

  18. Coldman L, Caldera DL. Risks of general anesthesia and elective operation in the hypertensive patient. Anesthesiology. 1979;50:285–92.

    Article  Google Scholar 

  19. Gullen DJ, Apolone G, Greenfeeld S, Guadagnoli E, Cleary P. ASA physical status and age predict morbidity after three surgical procedures. Ann Surg. 1994;220:3–9.

    Article  Google Scholar 

  20. Fisher JD. New York Heart Association classification. Arch Intern Med. 1972;129:836.

    Article  PubMed  CAS  Google Scholar 

  21. Reich DL, Hossain S, Krol M, Baez B, Patel P, Bernstein A, Bodian CA. Predictors of hypotension after induction of general anesthesia. Anesth Analg. 2005;101:622–8.

    Article  PubMed  Google Scholar 

  22. Bijker JB, van Klei WA, Kappen TH, van Wolfswinken L, Moons KG, Kalkman CJ. Incidence of intraoperative hypotension as a function of the chosen definition. Literature definitions applied to a retrospective cohort using automated data collection. Anesthesiology. 2007;107:213–20.

    Article  PubMed  Google Scholar 

  23. Gibson S, Farrell M. A review of age in the neurophysiology of nociception and the perpetual experience of pain. Clin J Pain. 2004;4:227–38.

    Article  Google Scholar 

  24. Altman DG. Practical statistics for medical research. London: Chapman & Hall; 1991. p. 74–106.

  25. Bennet-Guerrero E, Welsby I, Dunn TJ, Young LR, Wahl TI, Diers TL, Phillips-Bute BG, Newman MF, Mythen MG. The use of a postoperative morbidity survey to evaluate patients with prolonged hospitalization after routine, moderate risk, elective surgery. Anesth Analg. 1999;89:514–9.

    Google Scholar 

  26. Vacanti C, Van Houten R, Hill R. A statistical analysis of the relationship of physical status to postoperative morbidity in 68,388 cases. Anesth Analg. 1970;49:564–6.

    Article  PubMed  CAS  Google Scholar 

  27. Mc Bride WT, Armstrong MA, Mc Bride SJ. Immunomodulation: an important concept in modern anaesthesia. Anaesthesia. 1996;51:465–73.

    Article  CAS  Google Scholar 

  28. Mythen MG, Web AR. The role of gut mucosal hypoperfusion in the pathogenesis of post-operative organ dysfunction. Intensive Care Med. 1994;20:203–9.

    Article  PubMed  CAS  Google Scholar 

  29. Carli F. Perioperative factors influencing surgical morbidity: what the anesthesiologist needs to know. Can J Anesth. 1999;46:R70–9.

    Article  PubMed  CAS  Google Scholar 

  30. Salo M. Effects of anaesthesia and surgery on the immune response. Acta Anaesth Scand. 1992;36:201–20.

    Article  PubMed  CAS  Google Scholar 

  31. Grozier TA, Muller JE, Quittkat D, Sydow M, Wuttke W, Kettler D. Effects of anaesthesia on the cytokine response to abdominal surgery. Br J Anaesth. 1994;72:280–5.

    Article  Google Scholar 

  32. Kudoh A, Katagai H, Takazawa T, Matsuki A. Plasma proinflammatory cytokine response to surgical stress in elderly patients. Cytokine. 2001;15:270–3.

    Article  PubMed  CAS  Google Scholar 

  33. Kehlet H. Modification of responses to surgery by neural blockade: clinical implications. In: Cousins MJ, Bridenbaugh PO, editors. Neural blockade in clinical anesthesia and management of pain. 3rd ed. Philadelphia: Lippincott; 1998. p. 129–71.

  34. Liu SS, Carpenter RL, Neal JM. Epidural anesthesia and analgesia. Their role in postoperative outcome. Anesthesiology. 1995;82:1474–506.

    Article  PubMed  CAS  Google Scholar 

  35. Moiniche S, Hjorts NC, Hansen BL, Dahl JB, Rosenberg J, Gebuhr P, Kehlet H. The effect of balanced analgesia on early convalescence after major orthopaedic surgery. Acta Anaesth Scand. 1994;38:328–35.

    Article  PubMed  CAS  Google Scholar 

  36. Christensen T, Kehlet H. Postoperative fatigue. World J Surg. 1993;17:220–5.

    Article  PubMed  CAS  Google Scholar 

  37. Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth. 1997;78:606–17.

    PubMed  CAS  Google Scholar 

  38. Kehlet H, Dahl JB. Anaesthesia, surgery, and challenges in postoperative recovery. Lancet. 2003;362:1921–28.

    Google Scholar 

  39. De Camp MM, Demling R. Posttraumatic multisystem organ failure. JAMA. 1988;260:530–4.

    Article  Google Scholar 

  40. Hamilton-Davies C, Mythen MG, Salmon JB, Jacobson D, Shukla A, Webb AR. Comparison of commonly used clinical indicators of hypovolemia with gastrointestinal tonometry. Intensive Care Med. 1997;23:276–81.

    Article  PubMed  CAS  Google Scholar 

  41. Marik PE. Gastric intramucosal pH: a better predictor of multiorgan dysfunction syndrome and death than oxygen-derived variables in patients with sepsis. Chest. 1993;104:225–9.

    Article  PubMed  CAS  Google Scholar 

  42. Chang MC, Cheatham ML, Nelson LD, Ratherford EJ, Morris JA Jr. Gastric tonometry supplements information provided by systemic indicators of oxygen transport. J Trauma. 1994;37:488–94.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors acknowledge E. Zintzaras, MSc, PhD, Assoc. Professor of Biomaths and Biometry in the University of Thessaly, for his key role in the study design, data management, and statistical analysis.

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Correspondence to George Tzovaras.

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Tassoudis, V., Vretzakis, G., Petsiti, A. et al. Impact of intraoperative hypotension on hospital stay in major abdominal surgery. J Anesth 25, 492–499 (2011). https://doi.org/10.1007/s00540-011-1152-1

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  • DOI: https://doi.org/10.1007/s00540-011-1152-1

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