Perioperative hypotension and discharge outcomes in non-critically injured trauma patients,a single centre retrospective cohort study |
| |
| Affiliation: | 1. Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, United States;3. Harborview Injury Prevention and Research Center, Seattle, WA, United States;4. Department of Epidemiology, University of Washington, Seattle, WA, United States;5. Center for Studies in Demography and Ecology, University of Washington, Seattle, WA, United States;1. Division of Pediatric Surgery, University of Tennessee, Health Science Center, Le Bonheur Children’s Hospital, 49 North Dunlap, Second Floor, Memphis, TN 38105, USA;2. Department of General Surgery, University of Tennessee, Health Science Center, 920 Madison Ave., Memphis, TN 38103, United States;1. Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran;2. Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran;3. Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden;4. School of Medical Sciences, Örebro University, Örebro, Sweden;5. Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden;6. Division of Trauma and Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden;7. Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran;1. Blizard Institute for Trauma and Neuroscience, Queen Mary University, London, E1 2AT, United Kingdom;2. London’s Air Ambulance, Bartshealth NHS Trust, London E1 1BB, United Kingdom;1. University of Washington, Seattle, USA;2. Universidad Peruana Cayetano Heredia, Lima, Peru;3. Universidad del Azuay, Cuenca, Ecuador;4. Hospital Nacional Guillermo Almenara, Lima, Peru;5. Clinica Foianini, Santa Cruz, Bolivia;6. Neuroscience Institute, Neurotrauma Group, El Bosque University, Bogotá, Colombia;1. Medical University of Graz, Department of Orthopedics and Trauma Surgery, Austria;2. AUVA Trauma Hospital Graz, Austria;3. University of Graz, Austria;4. State Hospital Hochsteiermark/Leoben, Department for Surgery, Austria;5. State Hospital Judenburg-Knittelfeld, Austria;6. Institute of Anatomy, Austria;1. Department of Trauma Surgery, Medical University Vienna, Vienna General Hospital, Austria;2. Division of General Thoracic Surgery, University Hospital Bern/Inselspital, Bern, Switzerland |
| |
| Abstract: | BackgroundThere is a lack of information on the effect of age on perioperative care and outcomes after minor trauma in the elderly. We examined the association between perioperative hypotension and discharge outcome among non-critically injured adult patients.MethodsWe conducted a retrospective study of non-critically ill patients (ISS <9 or discharged within less than 24 h) who received anaesthesia care for surgery and Recovery Room care at a level-1 trauma centre between 5/1/2012 and 11/30/2013. Perioperative hypotension was defined as systolic blood pressure (SBP) <90 mmHg (traditional measure) for all patients, and SBP <110 mmHg (strict measure) for patients ≥65 years. Poor outcome was defined as death or discharge to skilled nursing facility/hospice.Results1744 patients with mean ISS 4.4 across age groups were included; 169 (10%) were ≥65 years. Among patients ≥ 65 years, intraoperative hypotension occurred in >75% (131/169, traditional measure) and in >95% (162/169, strict measure); recovery room hypotension occurred in 2% (4/169) and 29% (49/169), respectively. Mean age-adjusted anaesthetic agent concentration (MAC) was similar across age groups. Opioid use decreased from 9.3 (SD 5.7) mg/h morphine equivalents in patients <55 years to 6.2 (SD 4.0) mg/h in patients over 85 years. Adjusted for gender, ASA score, anaesthesia duration, morphine equivalent/hr, fluid balance, MAC and surgery type, and using traditional definition, older patients were more likely than patients <55 to experience perioperative hypotension: aRR 1.21, 95% CI 1.11–1.30 for 55–64 and aRR 1.19, 95% CI 1.07–1.32 for ages 65–74. Perioperative hypotension was associated with poor discharge outcome (aRR 1.55; 95% CI 1.04–2.31 and aRR 1.87; 95% CI 1.17–2.98, respectively).ConclusionDespite age related reduction in doses of volatile anaesthetic and opioids administered during anaesthesia care, and regardless of hypotension definition used, non-critically injured patients undergoing surgery experience a large perioperative hypotension burden. This burden is higher for patients 55–74 years and older and is a risk factor for poor discharge outcomes, independent of age and ASA status. |
| |
| Keywords: | Trauma Elderly Injury Hypotension Geriatrics Perioperative Anaesthesia |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
