• Steven D Glassman, Leah Y Carreon, Mladen Djurasovic, Desiree Chappell, Wael Saasouh, Christy L Daniels, Colleen H Mahoney, Morgan E Brown, and Jeffrey L Gum.
• Norton Leatherman Spine Center, Louisville, KY.
• Spine. 2025 Jan 15; 50 (2): 758075-80.

Study DesignRetrospective observational cohort.ObjectivesThis study explores the impact of Intraoperative hypotension (IOH) on postoperative complications for major thoracolumbar spine fusion procedures.Summary Of Background DataIOH with mean arterial pressure (MAP) <65 mm Hg is associated with postoperative acute kidney injury (AKI) in general surgery. In spinal deformity surgery, IOH is a contributing factor to MEP changes and spinal cord dysfunction with deformity correction.MethodsA total of 539 thoracolumbar fusion cases, more than six surgical levels and >3 hours duration, were identified. Anesthetic/surgical data included OR time, fluid volume, blood loss, blood product replacement and use of vasopressors. Arterial-line based MAP data was collected at 1-minute intervals. Cummulative duration of MAP <65 mm Hg was recorded. IOH within the first hour of surgery vs. the entire case was determined. Post-op course and complications including SSI, GI complications, pulmonary complications, MI, DVT, PE, AKI, and encephalopathy were noted. Cumulative complications were grouped as none, one to two complications, or more than three complications.ResultsThere was a significant association between occurrence of complications and duration of IOH within the first hour of surgery (8.2 vs . 5.6 min, P <0.001) and across the entire procedure (28.1 vs . 19.3 min, P =0.008). This association persisted for individual major complications including SSI, acute respiratory failure, PE, ileus requiring NGT, and postoperative cognitive dysfunction. Comparison of patients with zero versus one to two versus three or more complications demonstrated that patients with three or more complications had a longer duration of IOH in the first hour of the surgery and that patients who had no complications received less vasopressor than patients who had one to two or three or more complications.ConclusionThis study identifies duration of IOH during the first hour of surgery as a previously unrecognized modifiable risk associated with major complications for multilevel lumbar fusion surgery.Level Of EvidenceIII.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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