#341 Effect of Hypertension in Surgical Outcomes after Lumbar Spine Surgery
Poster Presented by: K. Singh
A.J. Marquez-Lara (1)
S.V. Nandyala (1)
S.J. Fineberg (1)
M. Noureldin (1)
K. Singh (1)
(1) Rush University Medical Center, Orthopaedic Surgery, Chicago, IL, United States
Introduction: Hypertension is a common condition present in patients undergoing lumbar spine surgery (LSS). The purpose of this study was to analyze the impact of hypertension with regards to patient outcomes and hospital resource utilization after LSS.
Methods: The Nationwide Inpatient Sample (NIS) database was queried from 2002-2011. Patients who underwent an elective lumbar decompression (LD) or lumbar fusion (LF) to treat degenerative pathology were selected and separated into cohorts. Patients with hypertension were identified within each surgical cohort. Demographics, comorbidities (CCI), length of stay (LOS) and costs were compared between hypertensive and normotensive patients. SPSS v.20 was utilized for statistical analysis with independent T-tests for discrete variables and χ2-tests for categorical data. A multinomial logistic regression analysis determined if hypertension was an independent predictor of postoperative complications after controlling for age, other comorbidities, and hospital characteristics.
Results: A total of 292,835 LDs and 264,944 LFs were identified between 2002-2011. There were 128,827 (43.9%) and 119,550 (45.1%) hypertensive patients in the LD and LF cohorts respectively. Regardless of surgical technique, hypertensive patients were significantly older and demonstrated a greater comorbidity burden (CCI) than normotensive patients (p< 0.001). Patients with high blood pressure incurred a greater LOS and in-hospital costs (p< 0.001). In both surgical cohorts, hypertensive patients demonstrated a greater incidence of postoperative deep vein thrombosis (DVT), cardiac events, hemorrhagic anemia, urinary tract infection (UTI), and ileus (p< 0.001). In the LD cohort, hypertension was also associated with greater incidences of postoperative surgical site infection (SSI), hematomas, and gastrointestinal (GI) bleeding. There were no significant differences in mortality between hypertensive and normotensive patients. Regression analysis demonstrated that hypertension was an independent predictor of postoperative hemorrhagic anemia and UTI.
Conclusion: Hypertension is present in nearly half of the patients undergoing a LD or LF. Hypertensive patients were older, demonstrated a greater comorbidity burden, and incurred a greater number of postoperative complications. The increased comorbidity burden likely contributed to the greater LOS and total hospital costs demonstrated among hypertensive patients. Interestingly, hypertension was not associated with a greater mortality rate. In light of these findings, further studies are warranted to determine if adequate peri-operative blood pressure control can reduce the rate of postoperative complications and the utilization of hospital resources.