Vasoplegia Following Complex Spine Surgery: Incidence and Risk.

Publication Title

Global Spine J

Authors

Basem Ishak, Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USAFollow
Juan N Pulido, Cardiovascular Intensive Care Unit, Department of Cardiothoracic Anesthesiology and Critical Care Medicine, Swedish Heart and Vascular Institute, Swedish Medical Center, US Anesthesia Partners Washington, Seattle, Wash.Follow
Alexander von Glinski, Swedish Neuroscience Institute, Swedish Medical CenterFollow
Darius Ansari, Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USAFollow
Rod J Oskouian, Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USAFollow
Jens R Chapman, Swedish Neuroscience InstituteFollow

Document Type

Article

Publication Date

5-29-2022

Keywords

washington; swedish neuro; swedish heart

Abstract

STUDY DESIGN: Retrospective cohort study.

OBJECTIVES: Vasoplegia is a life-threatening form of distributive or vasodilatory shock that is characterized by reduced systemic vascular resistance with resultant hypotension and normal to elevated cardiac output affecting morbidity and mortality. Vasoplegia in the context of Spine Surgery has not been described previously. The purpose of this case series is to determine incidence, risk factors, complications and postoperative outcome in patients with vasoplegia after complex multi-level thoraco-lumbar spine surgery.

METHODS: A retrospective review of the electronic medical records at our institution was conducted between January 2014 and June 2018. All patients undergoing multi-level spine surgery (>6 levels) were screened for intraoperative hypotension. Patient demographics, surgical characteristics, neurological status, blood loss, risk factors, medical treatment, complications, hospital course and mortality were collected. All patients included in this study had a minimum follow-up period of 3 months.

RESULTS: Out of 8521 surgically treated patients, 994 patients with multi-level thoraco-lumbar spine surgery were identified. A total of 41 patients had intraoperative hypotensive events. Of those, 5 patients with vasoplegia could be identified after elimination of all other potential contributing factors. Vasoplegia did not influence the neurological outcome. One major and three minor complications occurred. All patients showed full recovery. The risk factors identified for vasoplegia include prolonged surgery with osteotomies.

CONCLUSIONS: Vasoplegia is a rare condition with an incidence of .6%. Patients experiencing vasoplegia did not appear to experience worse surgical outcomes. The use of special intraoperative hemodynamic monitoring should be considered in selected cases.

Clinical Institute

Cardiovascular (Heart)

Clinical Institute

Neurosciences (Brain & Spine)

Specialty/Research Institute

Cardiology

Specialty/Research Institute

Neurosciences

Specialty/Research Institute

Surgery