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Elevated preoperative blood pressure and its relationship to intraoperative mean arterial pressure and blood loss in posterior spinal fusion for adolescent idiopathic scoliosis

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

The relationship between preoperative blood pressure (BP) and intraoperative mean arterial pressure (MAP) and estimated blood loss (EBL) in pediatric spine surgery is currently unknown. The objectives of this study were to determine if elevated preoperative BP is associated with elevated intraoperative MAP, EBL, and percentage estimated blood volume (EBV) lost, and to determine if intraoperative MAP is associated with percentage of EBV lost during posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS).

Methods

This is a retrospective cohort analysis of 209 patients undergoing PSF for AIS between 2016 and 2019 by a single surgeon. Data extracted included demographic characteristics, preoperative systolic and diastolic BP, continuous intraoperative MAP measured by arterial line, EBL, radiographic, and surgical characteristics. Time points of interest for MAP included incision and exposure. Elevated BP was defined as > 1 standard deviation above the mean BP of patients included in the study, and elevated MAP was defined as > 65 mmHg.

Results

Elevated preoperative systolic BP was associated with elevated MAP at incision (p = 0.002). Patients with elevated preoperative diastolic BP had significantly higher MAP at exposure and throughout the procedure (p = 0.04). MAP > 65 at incision was associated with a 5% increase in EBV lost (p < 0.001).

Conclusions

Patients with elevated preoperative BP parameters have increased MAPs at incision, exposure, and throughout surgery. Elevated MAP at incision is associated with an increased percentage of EBV lost in a small number of patients undergoing PSF for AIS.

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References

  1. Konieczny MR, Senyurt H, Krauspe R (2013) Epidemiology of adolescent idiopathic scoliosis. J Child Orthop 7:3–9

    Article  PubMed  Google Scholar 

  2. Hu SS (2004) Blood loss in adult spinal surgery. Eur Spine J 13(Suppl 1):S3-5

    Article  PubMed  PubMed Central  Google Scholar 

  3. Schwarzkopf R, Chung C, Park JJ et al (2010) Effects of perioperative blood product use on surgical site infection following thoracic and lumbar spinal surgery. Spine 35:340–6

    Article  PubMed  Google Scholar 

  4. Shulman G, Solanki DR, Hadjipavlou A (1998) Augmented autologous transfusions in major reconstructive spine surgery. J Clin Apher 13:62–68

    Article  CAS  PubMed  Google Scholar 

  5. Hur SR, Huizenga BA, Major M (1992) Acute normovolemic hemodilution combined with hypotensive anesthesia and other techniques to avoid homologous transfusion in spinal fusion surgery. Spine 17:867–73

    Article  CAS  PubMed  Google Scholar 

  6. Verma K, Lonner B, Dean L et al (2013) Reduction of Mean Arterial Pressure at Incision Reduces Operative Blood Loss in Adolescent Idiopathic Scoliosis. Spine Deform 1:115–122

    Article  PubMed  Google Scholar 

  7. Vitale MG, Levy DE, Park MC et al (2002) Quantifying risk of transfusion in children undergoing spine surgery. Spine J 2:166–172

    Article  PubMed  Google Scholar 

  8. Dutton RP (2004) Controlled hypotension for spinal surgery. Eur Spine J 13(Suppl 1):S66-71

    Article  PubMed  PubMed Central  Google Scholar 

  9. Jain A, Njoku DB, Sponseller PD (2012) Does patient diagnosis predict blood loss during posterior spinal fusion in children? Spine 37:1683–7

    Article  PubMed  Google Scholar 

  10. Ialenti MN, Lonner BS, Verma K et al (2013) Predicting operative blood loss during spinal fusion for adolescent idiopathic scoliosis. J Pediatr Orthop 33:372–376

    Article  PubMed  Google Scholar 

  11. Lam SK, Pan IW, Harris DA et al (2015) Patient-, procedure-, and hospital-related risk factors of allogeneic and autologous blood transfusion in pediatric spinal fusion surgery in the United States. Spine 40:560–9

    Article  PubMed  Google Scholar 

  12. Modi HN, Suh SW, Hong JY et al (2010) Intraoperative blood loss during different stages of scoliosis surgery: a prospective study. Scoliosis 5:16

    Article  PubMed  PubMed Central  Google Scholar 

  13. Hansen ML, Gunn PW, Kaelber DC (2007) Underdiagnosis of hypertension in children and adolescents. JAMA 298:874–879

    Article  CAS  PubMed  Google Scholar 

  14. McNiece KL, Poffenbarger TS, Turner JL, Franco KD, Sorof JM, Portman RJ (2007) Prevalence of hypertension and pre-hypertension among adolescents. J Pediatr 150(6):640–644

    Article  PubMed  Google Scholar 

  15. Flynn JT. (2017) AAP guidelines for childhood hypertension. Available at https://publications.aap.org/pediatrics/article/140/3/e20171904/38358/Clinical-Practice-Guideline-for-Screening-and. Accessed on 15 Oct 2022

  16. De la Garza RR, Goodwin CR, Abu-Bonsrah N et al (2016) Patient and operative factors associated with complications following adolescent idiopathic scoliosis surgery: an analysis of 36,335 patients from the Nationwide Inpatient Sample. J Neurosurg Pediatr 25:730–736

    Google Scholar 

  17. Redwine KM, Falkner B (2012) Progression of prehypertension to hypertension in adolescents. Curr Hypertens Rep 14(6):619–625. https://doi.org/10.1007/s11906-012-0299-y

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Fisher J, Paton J (2012) The sympathetic nervous system and blood pressure in humans: implications for hypertension. J Hum Hypertens 26:463–475. https://doi.org/10.1038/jhh.2011.66

    Article  CAS  PubMed  Google Scholar 

  19. Linderman GC, Jiapeng L, Yuan L, Sun X, Wei X, Nasir K, Schulz W, Jiang L, Krumholz HM (2018) Association of body mass index with blood pressure among 1.7 million Chinese adults. JAMA Netw Open 1(4):e181271. https://doi.org/10.1001/jamanetworkopen.2018.1271

    Article  PubMed  PubMed Central  Google Scholar 

  20. Neter JE, Stam BE, Kok FJ et al (2003) Influence of weight reduction on blood pressure: a meta-analysis of randomized controlled trials. Hypertension 42:878–884

    Article  CAS  PubMed  Google Scholar 

  21. Stevens VJ, Obarzanek E, Cook NR et al (2001) Long-term weight loss and changes in blood pressure: results of the trials of hypertension prevention, phase II. Ann Intern Med 134:1–11

    Article  CAS  PubMed  Google Scholar 

  22. Skinner AC, Ravanbakht SN, Skelton JA et al (2018) Prevalence of obesity and severe obesity in US children, 1999–2016. Pediatrics. https://doi.org/10.1542/peds.2017-3459

    Article  PubMed  Google Scholar 

  23. Ashraf M, Irshad M, Parry NA (2020) Pediatric hypertension: an updated review. Clin Hypertens 26(1):22

    Article  PubMed  PubMed Central  Google Scholar 

  24. Stewart M, Scattoloni J, Tazhibi G, Nafiu OO (2016) Association of elevated preoperative blood pressure with preincision hypotension in pediatric surgical patients. Paediatr Anaesth 26(8):844–851

    Article  PubMed  PubMed Central  Google Scholar 

  25. Freeman AD, Fitzgerald CA, Baxter KJ, Neff LP, McCracken CE, Bryan LN, Morsberger JL, Zahid AM, Santore MT (2020) Does hypertension at initial presentation adversely affect outcomes in pediatric traumatic brain injury? J Pediatr Surg 55(4):702–706

    Article  PubMed  Google Scholar 

  26. Verma K, Errico T, Diefenbach C et al (2014) The relative efficacy of antifibrinolytics in adolescent idiopathic scoliosis: a prospective randomized trial. J Bone Joint Surg Am 96(80):1–10

    Google Scholar 

  27. Pahys JM, Guille JT, D’Andrea LP et al (2009) Neurologic injury in the surgical treatment of idiopathic scoliosis: guidelines for assessment and management. J Am Acad Orthop Surg 17:426–434

    Article  PubMed  Google Scholar 

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Funding

No funding was received in support of this study.

Author information

Author notes

  1. Paul D. Sponseller and Dolores B. Njoku should be considered co-senior authors.

Authors and Affiliations

  1. Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD, 21287, USA

    Niyathi Prasad, Amit Jain, Rachel S. Bronheim, Majd Marrache & Paul D. Sponseller

  2. Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Dolores B. Njoku

  3. Department of Anesthesiology and Pain Medicine, Washington University in St. Louis, St. Louis, MO, USA

    Dolores B. Njoku

Authors
  1. Niyathi Prasad
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  2. Amit Jain
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  3. Rachel S. Bronheim
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  4. Majd Marrache
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  5. Dolores B. Njoku
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  6. Paul D. Sponseller
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Contributions

NP: Acquisition of data, analysis of data, interpretation of data, drafting of the article; revising it critically for important intellectual content, final approval of version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. AJ: Substantial contributions to conception and design, revising it critically for important intellectual content, final approval of version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. RSB: Interpretation of data, drafting of the article; revising it critically for important intellectual content, final approval of version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. MM: Analysis of data, interpretation of data; revising it critically for important intellectual content, final approval of version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. DBN: Substantial contributions to conception and design, revising it critically for important intellectual content, final approval of version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. PDS: Substantial contributions to conception and design, Revising it critically for important intellectual content, final approval of version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Rachel S. Bronheim.

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All authors report no conflicts of interest.

Ethical approval

This study was approved by the IRB prior to the initiation of this study.

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Prasad, N., Jain, A., Bronheim, R.S. et al. Elevated preoperative blood pressure and its relationship to intraoperative mean arterial pressure and blood loss in posterior spinal fusion for adolescent idiopathic scoliosis. Eur J Orthop Surg Traumatol 34, 339–345 (2024). https://doi.org/10.1007/s00590-023-03652-5

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