Incidence of orthostatic hypotension and cardiovascular response to postoperative early mobilization in patients undergoing cardiothoracic and abdominal surgery

Masatoshi Hanada,Masato Oikawa,Ryo Kozu,Yuichi Tawara,Hiroshi Niwa,Shuntaro Sato,Susumu Eguchi,Yosuke Morimoto,Takeshi Nagayasu,Kiyoyuki Eishi,Takuro Miyazaki

doi:10.1186/s12893-017-0314-y

Masatoshi Hanada, Masato Oikawa + Show 9 more

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https://doi.org/10.1186/s12893-017-0314-y

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Abstract

BackgroundIn cardiothoracic and abdominal surgery, postoperative complications remain major clinical problems. Early mobilization has been widely practiced and is an important component in preventing complications, including orthostatic hypotension (OH) during postoperative management. We investigated cardiovascular response during early mobilization and the incidence of OH after cardiothoracic and abdominal surgery.MethodsIn this prospective observational study, we consecutively analyzed data from 495 patients who underwent elective cardiothoracic and abdominal surgery. We examined the incidence of OH, and the independent risk factors associated with OH during early mobilization after major surgery. Multivariate logistic regression was performed using various characteristics of patients to identify OH-related independent factors.ResultsOH was observed in 191 (39%) of 495 patients. The incidence of OH in cardiac, thoracic, and abdominal groups was 39 (33%) of 119, 95 (46%) of 208, and 57 (34%) of 168 patients, respectively. Male sex (OR 1.538; p = 0.03) and epidural anesthesia (OR 2.906; p < 0.001) were independently associated with OH on multivariate analysis.ConclusionsThese results demonstrate that approximately 40% patients experience OH during early mobilization after cardiothoracic and abdominal surgery. Sex was identified as an independent factor for OH during early mobilization after all three types of surgeries, while epidural anesthesia was only identified after thoracic surgery. Therefore, the frequent occurrence of OH during postoperative early mobilization should be recognized.Trial registrationUniversity hospital Medical Information Network Center (UMIN-CTR) number UMIN000018632. (Registered on 1st October, 2008).

Highlights

In cardiothoracic and abdominal surgery, postoperative complications remain major clinical problems
A total of 544 patients who had undergone cardiothoracic and abdominal surgery were evaluated in a prospective cohort study (Fig. 1)
Four hundred ninety-five postoperative patients were categorized into cardiac group (n = 119, aged 74 interquartile range (IQR), 66-79 years), thoracic group (n = 208, aged 65 IQR, 58-73 years), and abdominal group (n = 168, aged 72 IQR, 64-78 years)

Summary

Introduction

In cardiothoracic and abdominal surgery, postoperative complications remain major clinical problems. Mobilization has been widely practiced and is an important component in preventing complications, including orthostatic hypotension (OH) during postoperative management. We investigated cardiovascular response during early mobilization and the incidence of OH after cardiothoracic and abdominal surgery. OH is a well-known clinical complication that can delay early mobilization, relatively little data are available regarding its mechanism and possible treatment [10]. Previous studies have documented a 12-19% rate of incidence of OH during early postoperative mobilization in patients who were treated for breast cancer, had undergone hip arthroplasty, or had received some type of gynecological treatment [12,13,14,15]. One study assessed the cardiovascular response and orthostatic intolerance to early mobilization after videoassisted thoracic surgery (VATS). This study demonstrated a 35% incidence of OH [16]

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