Intraoperative hypotension in non-emergency decompression surgery for cervical spondylosis: The role of chronic arterial hypertension

Ting-Yun Chiang; Yen-Kai Wang; Wen-Cheng Huang; Shiang-Suo Huang; Ya-Chun Chu

doi:10.3389/fmed.2022.943596

Intraoperative hypotension in non-emergency decompression surgery for cervical spondylosis: The role of chronic arterial hypertension

Front Med (Lausanne). 2022 Oct 18:9:943596. doi: 10.3389/fmed.2022.943596. eCollection 2022.

Authors

Ting-Yun Chiang¹, Yen-Kai Wang¹, Wen-Cheng Huang^{2

3}, Shiang-Suo Huang^{4

5}, Ya-Chun Chu^{1

2}

Affiliations

¹ Department of Anesthesiology, Taipei Veterans General Hospital, Taipei City, Taiwan.
² School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.
³ Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei City, Taiwan.
⁴ Department of Pharmacology, Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
⁵ Department of Pharmacy, Chung Shan Medical University Hospital, Taichung, Taiwan.

Abstract

Background: Cervical spondylotic myelopathy and chronic hypertension show a cause-effect relationship. Hypertension increases cardiovascular risk and is associated with intraoperative hypotension. We aimed to evaluate intraoperative hypotension in patients undergoing non-emergency decompression surgery for cervical spondylosis and its association with clinical myelopathy and chronic arterial hypertension.

Methods: This retrospective cohort study used healthcare data of adult patients undergoing cervical spine surgeries at Taipei Veterans General Hospital from 2015 to 2019. The primary outcomes were the incidence of intraoperative hypotension and predictive factors, and the secondary outcomes were the association of intraoperative hypotension and postoperative adverse outcomes in the surgical population.

Results: Among the 1833 patients analyzed, 795 (43.4%) required vasopressor treatment and 342 (18.7%) showed persistent hypotension. Factors independent associated with hypotension after anesthetic induction were age [odds ratio (OR), 1.15; 95% confidence interval (CI), 1.07-1.23 per 5 years, P < 0.001], male sex (OR, 1.63; 95% CI, 1.21-2.19, P < 0.001), chronic hypertension (OR, 1.77; 95% CI, 1.32-2.38, P < 0.001), upper cervical spine level C0-2 treated (OR, 3.04; 95% CI, 1.92-4.84, P < 0.001 vs. C3-T1), and increased number of spine segments treated (OR, 1.43; 95% CI 1.26-1.63, P < 0.001). Patients who developed intraoperative hypotension experienced more acute postoperative kidney injury (OR, 7.90; 95% CI, 2.34-26.63, P < 0.001), greater need for intensive care (OR, 1.80; 95% CI, 1.24-2.60, P = 0.002), and longer admission after surgery (1.09 days longer, 95% CI 0.06-2.12, P = 0.038).

Conclusion: Intraoperative hypotension is common even in non-emergency cervical spine surgery. A history of hypertension independently predicted intraoperative hypotension. Prompt assessments for identifiable features can help ameliorate intraoperative hypotension.

Keywords: cervical spondylosis; chronic hypertension; intraoperative hypotension; myelopathy; non-emergency; ossification of posterior longitudinal ligament.