Obesity & hypertension are determinants of poor hemodynamic control during total joint arthroplasty: a retrospective review

<p>Abstract</p> <p>Background</p> <p>Proper blood pressure control during surgical procedures such as total joint arthroplasty (TJA) is considered critical to good outcome. There is poor understanding of the pre-operative risk factors for poor intra-operative hemodynami...

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Main Authors: Nwachukwu Benedict U, Collins Jamie E, Nelson Emily P, Concepcion Mercedes, Thornhill Thomas S, Katz Jeffrey N
Format: Article
Language:English
Published: BMC 2013-01-01
Series:BMC Musculoskeletal Disorders
Subjects:
Online Access:http://www.biomedcentral.com/1471-2474/14/20
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author Nwachukwu Benedict U
Collins Jamie E
Nelson Emily P
Concepcion Mercedes
Thornhill Thomas S
Katz Jeffrey N
author_facet Nwachukwu Benedict U
Collins Jamie E
Nelson Emily P
Concepcion Mercedes
Thornhill Thomas S
Katz Jeffrey N
author_sort Nwachukwu Benedict U
collection DOAJ
description <p>Abstract</p> <p>Background</p> <p>Proper blood pressure control during surgical procedures such as total joint arthroplasty (TJA) is considered critical to good outcome. There is poor understanding of the pre-operative risk factors for poor intra-operative hemodynamic control. The purpose of this study is to identify risk factors for poor hemodynamic control during TJA.</p> <p>Methods</p> <p>We performed a retrospective cohort analysis of 118 patients receiving TJA in the Dominican Republic. We collected patient demographic and comorbidity data. We developed an a priori definition for poor hemodynamic control: 1) Mean arterial pressure (MAP) <65% of preoperative MAP or 2) MAP >135% of preoperative MAP. We performed bivariate and multivariate analyses to identify risk factors for poor hemodynamic control during TJA.</p> <p>Results</p> <p>Hypertension was relatively common in our study population (76 of 118 patients). Average preoperative mean arterial pressure was 109.0 (corresponding to an average SBP of 149 and DBP of 89). Forty-nine (41.5%) patients had intraoperative blood pressure readings consistent with poor hemodynamic control. Based on multi-variable analysis preoperative hypertension of any type (RR 2.9; 95% CI 1.3-6.3) and an increase in BMI (RR 1.2 per 5 unit increase; 95% CI 1.0-1.5) were significant risk factors for poor hemodynamic control.</p> <p>Conclusions</p> <p>Preoperative hypertension and being overweight/obese increase the likelihood of poor blood pressure control during TJA. Hypertensive and/or obese patients warrant further attention and medical optimization prior to TJA. More work is required to elucidate the relationship between these risk factors and overall outcome.</p>
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spelling doaj.art-999679068a5944b587ac6b468294323a2022-12-21T19:07:26ZengBMCBMC Musculoskeletal Disorders1471-24742013-01-011412010.1186/1471-2474-14-20Obesity & hypertension are determinants of poor hemodynamic control during total joint arthroplasty: a retrospective reviewNwachukwu Benedict UCollins Jamie ENelson Emily PConcepcion MercedesThornhill Thomas SKatz Jeffrey N<p>Abstract</p> <p>Background</p> <p>Proper blood pressure control during surgical procedures such as total joint arthroplasty (TJA) is considered critical to good outcome. There is poor understanding of the pre-operative risk factors for poor intra-operative hemodynamic control. The purpose of this study is to identify risk factors for poor hemodynamic control during TJA.</p> <p>Methods</p> <p>We performed a retrospective cohort analysis of 118 patients receiving TJA in the Dominican Republic. We collected patient demographic and comorbidity data. We developed an a priori definition for poor hemodynamic control: 1) Mean arterial pressure (MAP) <65% of preoperative MAP or 2) MAP >135% of preoperative MAP. We performed bivariate and multivariate analyses to identify risk factors for poor hemodynamic control during TJA.</p> <p>Results</p> <p>Hypertension was relatively common in our study population (76 of 118 patients). Average preoperative mean arterial pressure was 109.0 (corresponding to an average SBP of 149 and DBP of 89). Forty-nine (41.5%) patients had intraoperative blood pressure readings consistent with poor hemodynamic control. Based on multi-variable analysis preoperative hypertension of any type (RR 2.9; 95% CI 1.3-6.3) and an increase in BMI (RR 1.2 per 5 unit increase; 95% CI 1.0-1.5) were significant risk factors for poor hemodynamic control.</p> <p>Conclusions</p> <p>Preoperative hypertension and being overweight/obese increase the likelihood of poor blood pressure control during TJA. Hypertensive and/or obese patients warrant further attention and medical optimization prior to TJA. More work is required to elucidate the relationship between these risk factors and overall outcome.</p>http://www.biomedcentral.com/1471-2474/14/20HipKneeBlood pressureTotal joint arthroplastyObesityHypertension
spellingShingle Nwachukwu Benedict U
Collins Jamie E
Nelson Emily P
Concepcion Mercedes
Thornhill Thomas S
Katz Jeffrey N
Obesity & hypertension are determinants of poor hemodynamic control during total joint arthroplasty: a retrospective review
BMC Musculoskeletal Disorders
Hip
Knee
Blood pressure
Total joint arthroplasty
Obesity
Hypertension
title Obesity & hypertension are determinants of poor hemodynamic control during total joint arthroplasty: a retrospective review
title_full Obesity & hypertension are determinants of poor hemodynamic control during total joint arthroplasty: a retrospective review
title_fullStr Obesity & hypertension are determinants of poor hemodynamic control during total joint arthroplasty: a retrospective review
title_full_unstemmed Obesity & hypertension are determinants of poor hemodynamic control during total joint arthroplasty: a retrospective review
title_short Obesity & hypertension are determinants of poor hemodynamic control during total joint arthroplasty: a retrospective review
title_sort obesity hypertension are determinants of poor hemodynamic control during total joint arthroplasty a retrospective review
topic Hip
Knee
Blood pressure
Total joint arthroplasty
Obesity
Hypertension
url http://www.biomedcentral.com/1471-2474/14/20
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AT nelsonemilyp obesityhypertensionaredeterminantsofpoorhemodynamiccontrolduringtotaljointarthroplastyaretrospectivereview
AT concepcionmercedes obesityhypertensionaredeterminantsofpoorhemodynamiccontrolduringtotaljointarthroplastyaretrospectivereview
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