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Intraoperative physiological ranges associated with improved outcomes after major spine surgery: an observational study
  1. Gang Li1,
  2. Liang Lin2,
  3. Jifang Xiao3,
  4. Stanley Rosenbaum4,
  5. Philip Bickler5,
  6. Lingzhong Meng4
  1. 1 Department of Anesthesiology, Peking University Third Hospital, Beijing, China
  2. 2 Department of Anesthesiology, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian Province, China
  3. 3 School of Medicine, Georgetown University, Washington, DC, USA
  4. 4 Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut, USA
  5. 5 Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California, USA
  1. Correspondence to Professor Lingzhong Meng; lingzhong.meng{at}yale.edu

Abstract

Objective There is inadequate information about the values of many intraoperative physiological measurements that are associated with improved outcomes after surgery. The purpose of this observational study is to investigate the optimal physiological ranges during major spine surgery.

Setting A teaching hospital in the USA.

Participants A convenience sample of 102 patients receiving major posterior spine surgery with multilevel spinal fusion in a prone position.

Methods Physiological variables, including but not limited to mean arterial pressure (MAP) and cerebral and somatic tissue oxygen saturation (SctO2/SstO2), were recorded. The results of these measurements were associated with length of hospital stay and composite complication data and were analysed based on thresholds (ie, a cut-off value for optimal and suboptimal physiology) and the area under the curve (AUC) values. The AUC values were measured as the area enclosed by the actual tracing and the threshold. The outcomes were dichotomised into above-average and below-average (ie, improved) categories.

Results Analyses based on thresholds identified the following variables associated with above-average outcomes: MAP <60 mm Hg, temperature <35°C, heart rate >90 beats per minute (bpm), SctO2 <60% and SstO2 >80%. Analyses based on AUC values identified the following as associated with above-average outcomes: MAP <70 and >100 mm Hg, temperature <36°C, heart rate >90 bpm, tidal volume (based on ideal body weight)<6 mL/kg, tidal volume (based on actual body weight) >10 mL/kg and peak airway pressure <15 cmH2O.

Conclusion The following physiological ranges are associated with improved outcomes (ie, shorter hospitalisation and fewer complications) during major spine surgery: MAP of 70–100 mm Hg, temperature ≥36°C, heart rate <90 bpm, tidal volume based on ideal body weight >6 mL/kg, SctO2 >60% and SstO2 <80%.

  • physiology
  • outcomes
  • threshold
  • area under the curve
  • surgery

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Footnotes

  • Contributors GL, LL and LM helped in conception and design of the work. GL, LL and JX contributed to acquisition of the data. GL, LL, JX, SR, PB and LM analysed and interpreted the data, drafted and critically revised the manuscript for important intellectual content, are accountable for all aspects of the work and approved the final manuscript.

  • Funding This work was supported by the Inaugural Anesthesia Department Awards for Seed Funding for Clinically-Oriented Research Projects from the Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California, USA (to LM). It is also supported by the Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut, USA.

  • Competing interests LM is a consultant to CAS Medical Systems, Inc. The other authors declare no competing interests.

  • Ethics approval The study was approved by the Institutional Review Board for Clinical Investigations at the University of California San Francisco, San Francisco, California, USA (IRB #: 14-12996; Reference #: 081259).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Additional unpublished data are not publicly available.

  • Patient consent for publication Obtained.

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