Cardiovascular instability after posterior thoracolumbar stabilization surgery: autonomic clues from a case-series analysis
Chirurgia (Turin), cilt.39, sa.4, ss.277-281, 2026 (ESCI, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 39 Sayı: 4
- Basım Tarihi: 2026
- Doi Numarası: 10.23736/s0394-9508.25.05984-4
- Dergi Adı: Chirurgia (Turin)
- Derginin Tarandığı İndeksler: Emerging Sources Citation Index (ESCI), Scopus, EMBASE
- Sayfa Sayıları: ss.277-281
- Anahtar Kelimeler: Spinal fusion, Thoracic vertebrae, Hypotension, Bradycardia, Autonomic nervous system, Intensive Care Units
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
BACKGROUND: Brady-arrhythmia and brief hypotension have been reported during lumbar instrumentation, yet the real burden of cardiovascular instability – especially the drug-resistant vasoplegia sometimes seen after surgery – remains unknown. We aimed to quantify hemodynamic complications after posterior thoracolumbar stabilization and to explore perioperative risk factors. METHODS: We reviewed 376 consecutive elective posterior thoracolumbar fixations (January 2018 to December 2023). After exclusions for trauma, tumor, revision surgery and incomplete records, 325 patients (mean age 59.8 ± 11.4 years; 61.5% female) formed the study cohort. Standardized general anesthesia, invasive arterial monitoring and forced-air warming were used. Transient bradycardia was defined as heart rate < 50 beats min-1 or ≥ 20% drop for ≥ 30 s; intraoperative hypotension as systolic blood pressure < 90 mmHg or mean arterial pressure (MAP) <60 mmHg for ≥ 1 min; resistant postoperative hypotension as systolic blood pressure <90 mmHg persisting ≥48 h despite fluid and vasopressor support. Logistic regression tested predictors of unplanned intensive-care-unit (ICU) admission. RESULTS: Transient bradycardia occurred in 6 patients (1.85%), all during L2-L3 root manipulation and resolved immediately after traction stopped. Intra-operative hypotension appeared in 74 cases (22.8%); 15 required short norepinephrine infusions. Seven patients (2.15%) developed previously undescribed resistant vasoplegic hypotension lasting 48-72 h. Overall, 62 patients (19.1%) needed unplanned ICU care. Thoracolumbar-junction involvement (adjusted odds ratio 2.73, 95% CI 1.46-5.12) and greater blood loss (adjusted odds ratio 1.81 per transfused unit, 95% CI 1.21-2.70) independently predicted admission. No perioperative mortality occurred. CONCLUSIONS: Cardiovascular instability is uncommon but clinically relevant after thoracolumbar fixation. This study provides the first incidence estimate for resistant postoperative hypotension and identifies junctional surgery and blood loss as modifiable risk factors. Advance arterial monitoring, active hemostatic strategies and early vasopressor support may improve patient safety.