Preoperative Blood Pressure Research Articles

The Effects of Progressive Muscle Relaxation on Preoperative Anxiety and Blood Pressure in Patient with Aneurysm

This study, conducted on diagnosed aneurysm patients, in order to test the effects of progressive muscle relaxation on blood pressure and anxiety levels in the preoperative period, was carried out in a quasi-experimental study with a pre-test and post-test application. The data of this study were collected between January 2022-September 2022 at the neurosurgery clinic on 38 patients (twenty women and eighteen men) who’ve been diagnosed with cerebral aneurysm, awaiting a surgical operation, and have other criteria to be taken into the study. Pre- and post-exercise vital signs and anxiety levels of patients receiving progressive muscle relaxation exercises for twenty minutes in the preoperative period were measured with the Visual Analogue Scale (VAS) and Beck Anxiety Inventory (BAI). Frequency analysis for descriptive statistics, and t-test analysis for blood pressure, pulse, respiration, BAI, and VAS scores in a single group were utilized. Progressive muscle relaxation exercises in the preoperative period for neurosurgery patients diagnosed with aneurysm have statistically significant effects in reducing the patients’ anxiety and blood pressure (p<0.001). It is recommended that progressive muscle relaxation exercises be used in the clinic during the preoperative period. A clinically important finding is the positive effect of progressive muscle relaxation exercises on patients' vital signs and anxiety.

Systemic Hypertension and Postoperative Symptomatic Spinal Epidural Hematoma: A Scoping Review.

Postoperative symptomatic spinal epidural hematoma (PSSEH) is a serious complication of spinal surgery that is associated with significant morbidity. Studies suggest that hypertension is a risk factor for the development of PSSEH. The aim of this review was to evaluate the literature reporting associations between hypertension and PSSEH. A comprehensive literature search was conducted using the MEDLINE/PubMed, Embase, and Cochrane Library databases to identify studies that investigated PSSEH and reported data on preoperative hypertension status and/or perioperative blood pressure (BP). Eighteen studies were identified for inclusion in the review. Observational data suggested that uncontrolled/untreated preoperative hypertension, extubation-related increases in systolic BP, and elevated postoperative systolic BP were associated with an increased risk of PSSEH. The overall quality of evidence was low because of the retrospective nature of the studies, heterogeneity, and lack of precision in reporting. Despite the limitations of the current evidence, our findings could be important in establishing preoperative BP targets for elective spine surgery and inform perioperative clinical decision-making, while allowing consideration of risk factors for PSSEH. Well-controlled studies are required to investigate further the relationship between BP and PSSEH.

Incidence and predictors of intraoperative hypotension during transurethral bladder tumor resection with oral 5-aminolevulinic acid.

To analyze the incidence and risk factors of intraoperative hypotension related to photodynamic diagnosis-assisted transurethral resection of bladder tumor (PDD-TURBT) with oral 5-aminolevulinic acid (5-ALA). We retrospectively analyzed 487 patients with bladder tumors who underwent PDD-TURBT (n = 184) or conventional TURBT (conv-TURBT) (n = 303) between 2018 and 2021. Intraoperative hypotension was defined as hypotension requiring vasopressors during TURBT, and its incidence was compared between the two groups. Potential risk factors of intraoperative hypotension, including preoperative change in mean arterial pressure (MAP), were further investigated in patients receiving PDD-TURBT. The median age was 72 years, 392 patients (81%) were male, and 203 (42%) had hypertension. TURBT was performed under general and spinal anesthesia in 76 (16%) and 411 (84%) patients, respectively. The incidence of intraoperative hypotension was significantly higher in PDD-TURBT compared to conv-TURBT (43% vs. 17%, respectively). The median change in MAP until the induction of anesthesia was +6.5 mmHg (range: -29.0 to +46.3) in the PDD-TURBT group and +14.7 mmHg (range: -35.3 to +67.7) in the conv-TURBT group, showing a significantly smaller increase in the PDD-TURBT group (p < 0.001). In the multivariable analysis for PDD-TURBT patients, advanced age, general anesthesia, and lower MAP change (<+6.5 mmHg) until anesthesia induction were significantly associated with intraoperative hypotension (p = 0.0104, <0.001, and <0.001, respectively). Intraoperative hypotension occurred more frequently in patients who underwent PDD-TURBT than in those who underwent conv-TURBT. Using oral 5-ALA decreases preoperative blood pressure elevation and may be responsible for intraoperative hypotension.

Abstract 18895: Myocardial Injury After Non-Cardiac Surgery (MINS) in the High Sensitivity Troponin Era: Current Trends of Preoperative Risk Stratification in a Large Urban Healthcare System

Introduction: Myocardial Injury after Non-Cardiac Surgery (MINS) is a significant cause of perioperative morbidity and mortality. Recognizing and understanding the patient characteristics and potential predictors of MINS can contribute to more effective patient risk stratification and management. Hypothesis: Certain preoperative risk factors are associated with a higher risk of developing MINS among patients undergoing noncardiac surgery. Methods: We retrospectively reviewed the data on 2458 noncardiac surgeries performed within the MedStar System between 2022-2023 in which patients underwent routine pre- and postoperative high sensitivity troponin I (hsTnI) and EKG monitoring over 72 hours. MINS was defined as any elevation in hsTnI &gt;99 th percentile for gender (&gt;34 ng/L: females, &gt;53 ng/L :males). Multivariable logistic regression models were used to identify the factors associated with MINS which included demographics, surgical details, comorbidities, relevant preoperative labs and vitals. Results: Out of the 2,458 patients, 889 (36%) were diagnosed with MINS. Patients with MINS were older, nonsmokers, and females with prior congestive heart failure (CHF), coronary artery disease (CAD), chronic kidney disease (CKD), atrial fibrillation, and preoperatively lower blood pressure and higher creatinine compared to patients without MINS (Table 1). In multivariable adjusted models, CHF [aOR=1.6, 95%CI: (1.1, 2.3)], CAD [aOR=2.1(14, 2.9)], CKD [aOR=1.4(1.2, 1.8)] were associated with higher odds of developing MINS. RCRI score was not associated with postop MINS. Figure 1 shows rates of developing MINS among surgical specialties. Conclusions: Our study demonstrates that risk factors including age, gender, pre-existing cardiovascular and renal disease, preoperative blood pressure, and certain surgery types are associated with MINS. Research is needed to further define how to utilize this information to identify and minimize the risk of MINS.

Lidocaine aerosol preoperative application for improving the comfort of pediatric patients undergoing tonsillectomy and adenoidectomy: A prospective randomized controlled trial.

The use of lidocaine aerosol for pediatric tonsil and adenoidectomy has been reported less frequently. We hope to improve the perioperative comfort of pediatric patients undergoing these procedures by applying lidocaine aerosol. A total of 122 pediatric patients receiving tonsil and adenoidectomy were randomly divided into a lidocaine aerosol group (Group L) and a saline group (Group C), with 61 patients in each group; 2.4% alkaline lidocaine aerosol and saline were sprayed in the pharynx before induction. Our primary outcome were the incidence and rate ratio (RR) of postoperative pharyngeal complications (oropharyngeal dryness, dysphagia, hoarseness, and sore throat) and the pharyngeal comfort score, the latter of which was assessed by the occurrence of the above complications (yes = 0 point, none = 1 point). The secondary outcomes included preoperative and intraoperative blood pressure and heart rate, the incidence of choking during the induction period, the intraoperative opioid dosage, and the pain level and depth of sedation at 2, 6, and 24 h postoperatively. Statistical software used in this study included PASS15.0, SPSS 26.0, and GraphPad Prism 9.3.1, and statistical methods used included the t-test, the χ² test, the Mann-Whitney U test, and the repeated measures analysis of variance. The incidence and RR of postoperative pharyngeal complications such as oropharyngeal dryness (RR: 0.667, 95% confidence interval [CI]: 0.458-0.970, p = 0.03), dysphagia (RR: 0.333, 95% CI: 0.114-0.976, p = 0.03), hoarseness (RR: 0.647, 95% CI: 0.433-0.967, p = 0.03), and sore throat (RR: 0.727, 95% CI: 0.547-0.967, p = 0.03) were significantly lower in Group L than in Group C at 2 h postoperatively, and the incidence and RR of postoperative sore throat was significantly lower in Group L than in Group C at 6 h postoperatively (RR: 0.717, 95% CI: 0.547-0.942, p = 0.01). The postoperative pharyngeal comfort scores were significantly higher in Group L than in Group C at all postoperative time points (p < 0.05). The Ramsay sedation score was significantly higher (p < 0.01) and FLACC (face, legs, activity, crying, and consolability) score was significantly lower (p < 0.01) in Group L than in Group C at 2 h postoperatively. In Group C, the blood pressure and heart rate significantly faster at all time points immediately after intubation and afterward, except at the end of surgery (p < 0.05). In pediatric tonsil and adenoidectomy, the application of lidocaine aerosol before induction can reduce the incidence of postoperative pharyngeal complications, improve the child's postoperative pharyngeal comfort, and better realize perioperative "comfort medical treatment."

OR02-02 Pre-operative Blood Pressure Response To Aldosterone Antagonists And Urinary Hybrid Steroid Ratios Predict Clinical Outcomes In Unilateral Primary Aldosteronism For At Least 2 Years Post-adrenalectomy

Abstract Disclosure: X. Wu: None. E. Goodchild: None. R. Senanayake: None. W. Bashari: None. J. Salsbury: None. C.P. Cabrera: None. G. Argentesi: None. S.M. O’Toole: None. J. McFarlane: None. M. Matson: None. L. Parvanta: None. N. Hilliard: None. V. Kosmoliaptsis: None. A. Marker: None. D.M. Berney: None. W. Tan: None. R. Foo: None. C.A. Mein: None. E. Wozniak: None. A. Sahdev: None. N. Bird: None. K. Laycock: None. E. Adeyeye: None. A. Dawnay: None. D. Gillett: None. A. Prete: None. A.E. Taylor: None. W. Arlt: None. A.N. Bhuva: None. C. Manisty: None. K.J. Cruickshank: None. H. Cheow: None. G. Mark: None. W. Drake: None. M.J. Brown: None. Introduction: A recent prospective, within-patient study (MATCH) demonstrated 11C-metomidate PET-CT is non-inferior to Adrenal Vein Sampling in accurately detecting unilateral Primary Aldosteronism (PA)1. At 6 months post-adrenalectomy 79.5% and 28.2% of patients achieved, respectively, partial/complete or complete clinical success (by PASO consensus). These outcomes reiterate the need for careful selection of patients for surgery, especially when a widely available non-invasive test could increase, by many-fold, the number of patients diagnosed with unilateral PA. In MATCH, age, sex, genotype of tumour and systolic blood pressure (SBP) response (reduction to &amp;lt;135 mmHg) after 4 weeks of Spironolactone therapy all predicted clinical success at 6 month-adrenalectomy. Aims and Methods: To determine whether these short-term clinical outcomes and the above predictors of success are sustained at 2-year follow-up; and establish whether baseline urinary hybrid steroid (18-OH cortisol/cortisol) ratio could assist clinical decision making by providing surrogate evidence of genotype and probability of clinical success. We report outcomes for all patients who had undergone adrenalectomy with ­­&amp;gt;2-year follow-up on 20th December 2022, including all 78/142 surgical patients in the original study, in addition to 18/40 in the study extension. Results: Partial/complete or complete clinical success were achieved in 78/96 (81%) and 24/96 (25%) of patients respectively. The mean defined daily dose of antihypertensives at 2 years was 1.32 (SD 1.76), comparable to 1.34 (1.90) at 6 months, and significantly lower than at baseline: 3.86 (2.47), t = 7.70, p = 0.0001. Younger age and female sex were associated with higher likelihood of complete clinical success (Fisher’s Exact test p = 0.0084 and p = 0.0001 respectively). Pre-operatively, SBP reduction to &amp;lt;135 mmHg after 4 weeks of spironolactone was seen in 10/23 patients and associated with higher likelihood of complete clinical success at 2 years (versus 6/39 complete clinical success in the SBP &amp;gt;135 mmHg group, Fisher’s exact test p = 0.0135). 13/18 (72%) of patients harbouring KCNJ5 mutations achieved complete clinical success at 2 years, compared to 1/20 (5%) with CACNA1D mutations. A baseline hybrid steroid ratio &amp;gt;2 was seen in 13/14 (93%) patients with KCNJ5 mutations. Absence of clinical success in the KCNJ5 cohort was seen in the only patient with a ratio &amp;lt;2. Conclusion: Favorable clinical outcomes seen at 6 months post-adrenalectomy were sustained at 2-year follow-up. SBP response to spironolactone and KCNJ5 genotype are both potential predictors of ongoing clinical success at 2 years. The presence of high urinary hybrid steroid ratios in patients with KCNJ5 mutations could highlight, pre-operatively, those likely to derive the most clinical benefit from surgery. 1. Nature Medicine, in press, https://doi.org/10.1038/s41591-022-02114-5 Presentation: Thursday, June 15, 2023

224 Surgical Repair of Mitral Valve Prolapse: Hypertension and Other Determinants of Failure

Abstract Aim It has been postulated that hypertension is associated with an increased likelihood of repair failure in patients with mitral valve prolapse. This study aims to assess whether there is a significant association between hypertension and disease recurrence and need for reoperation. Method A retrospective observational cohort study was conducted at a single centre in the United Kingdom. Patients who underwent surgical repair for mitral valve prolapse were identified between January 2011 and December 2020, with follow-up data collected to December 2021. Patients were classified as hypertensive if they had a pre- operative clinic blood pressure of 140/90 mm Hg or above. Treatment failure was confirmed by the presence of moderate or worse regurgitation on post-operative echocardiography and/or need for reoperation. Multivariate logistic regression and Cox regression were used for statistical analysis. Results A total of 278 patients were identified who had pre-operative blood pressure data available, of those 144 were hypertensive. By the conclusion of the study period, treatment failure occurred in 11.5% of the study sample. No significant association was identified between the presence of hypertension and treatment failure, or time to treatment failure. Concomitant atrial ablation was, however, found to be protective against treatment failure (odds ratio, 6.1; 95% confidence interval, 1.2 to 32.8) and associated with longer time to treatment failure (hazard ratio, 6.3; 95% confidence interval, 1.6 to 25.1). Conclusions There is insufficient evidence to demonstrate that hypertension is associated with treatment failure or time to treatment failure for patients undergoing surgical repair for mitral valve prolapse.

A novel explainable online calculator for contrast-induced AKI in diabetics: a multi-centre validation and prospective evaluation study

BackgroundIn patients undergoing percutaneous coronary intervention (PCI), contrast-induced acute kidney injury (CIAKI) is a frequent complication, especially in diabetics, and is connected with severe mortality and morbidity in the short and long term. Therefore, we aimed to develop a CIAKI predictive model for diabetic patients.Methods3514 patients with diabetes from four hospitals were separated into three cohorts: training, internal validation, and external validation. We developed six machine learning (ML) algorithms models: random forest (RF), gradient-boosted decision trees (GBDT), logistic regression (LR), least absolute shrinkage and selection operator with LR, extreme gradient boosting trees (XGBT), and support vector machine (SVM). The area under the receiver operating characteristic curve (AUC) of ML models was compared to the prior score model, and developed a brief CIAKI prediction model for diabetes (BCPMD). We also validated BCPMD model on the prospective cohort of 172 patients from one of the hospitals. To explain the prediction model, the shapley additive explanations (SHAP) approach was used.ResultsIn the six ML models, XGBT performed best in the cohort of internal (AUC: 0.816 (95% CI 0.777–0.853)) and external validation (AUC: 0.816 (95% CI 0.770–0.861)), and we determined the top 15 important predictors in XGBT model as BCPMD model variables. The features of BCPMD included acute coronary syndromes (ACS), urine protein level, diuretics, left ventricular ejection fraction (LVEF) (%), hemoglobin (g/L), congestive heart failure (CHF), stable Angina, uric acid (umol/L), preoperative diastolic blood pressure (DBP) (mmHg), contrast volumes (mL), albumin (g/L), baseline creatinine (umol/L), vessels of coronary artery disease, glucose (mmol/L) and diabetes history (yrs). Then, we validated BCPMD in the cohort of internal validation (AUC: 0.819 (95% CI 0.783–0.855)), the cohort of external validation (AUC: 0.805 (95% CI 0.755–0.850)) and the cohort of prospective validation (AUC: 0.801 (95% CI 0.688–0.887)). SHAP was constructed to provide personalized interpretation for each patient. Our model also has been developed into an online web risk calculator. MissForest was used to handle the missing values of the calculator.ConclusionWe developed a novel risk calculator for CIAKI in diabetes based on the ML model, which can help clinicians achieve real-time prediction and explainable clinical decisions.

Elevated preoperative blood pressure and its relationship to intraoperative mean arterial pressure and blood loss in posterior spinal fusion for adolescent idiopathic scoliosis.

The relationship between preoperative blood pressure (BP) and intraoperative mean arterial pressure (MAP) and estimated blood loss (EBL) in pediatric spine surgery is currently unknown. The objectives of this study were to determine if elevated preoperative BP is associated with elevated intraoperative MAP, EBL, and percentage estimated blood volume (EBV) lost, and to determine if intraoperative MAP is associated with percentage of EBV lost during posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). This is a retrospective cohort analysis of 209 patients undergoing PSF for AIS between 2016 and 2019 by a single surgeon. Data extracted included demographic characteristics, preoperative systolic and diastolic BP, continuous intraoperative MAP measured by arterial line, EBL, radiographic, and surgical characteristics. Time points of interest for MAP included incision and exposure. Elevated BP was defined as > 1 standard deviation above the mean BP of patients included in the study, and elevated MAP was defined as > 65mmHg. Elevated preoperative systolic BP was associated with elevated MAP at incision (p = 0.002). Patients with elevated preoperative diastolic BP had significantly higher MAP at exposure and throughout the procedure (p = 0.04). MAP > 65 at incision was associated with a 5% increase in EBV lost (p < 0.001). Patients with elevated preoperative BP parameters have increased MAPs at incision, exposure, and throughout surgery. Elevated MAP at incision is associated with an increased percentage of EBV lost in a small number of patients undergoing PSF for AIS.

Preoperative Assessment for Coronary Artery Bypass Graft: Going Back to the Basics

As doctors increasingly rely on technological advancements, ever-improving laboratory techniques, and imaging modalities, the importance of a thorough physical evaluation and bedside manner has been noticeably diminished. When it comes to patients scheduled for coronary artery bypass graft (CABG), the preoperative bilateral arm blood pressure (BP) measurement is often omitted; thus, sinister signs of atherosclerotic disease like the brachial gradient are neglected and the surgical plan is jeopardized. We present the case of a 72-year-old male listed for CABG, stressing the necessity of meticulous clinical examination and the routine use of color Doppler ultrasonography (CDUS), prior to surgery. This case aims to highlight the major role of thorough preoperative clinical assessment. The bilateral BP measurement and CDUS are two reliable, expeditious, noninvasive preoperative screening methods, which can detect patients with generalized atherosclerosis, altering, if necessary, the surgical plan, and aiming for the best possible outcome, without complications.

Association between preoperative blood pressure and outcomes in cardiac surgery: results of a prospectively planned cohort study.

It is unknown whether unwitnessed BP (UBP) measurement or ambulatory BP (ABP) monitoring improves the prediction of adverse events estimated by risk scores. We intended to study associations between preoperative BP measured through these two methods and the incidence of adverse outcomes in patients undergoing cardiac surgery. We included a cohort of 167 patients undergoing elective or urgent cardiac surgeries. Preoperative BP was measured by UBP and 24-hour ABP. Primary outcome was the combination of mortality from any cause, nonfatal myocardial infarction, nonfatal stroke, new hospital admission, and dialysis occurring within 30 days after surgery. The associations between preoperative BP and surgical outcomes were tested using the chi-square test and Analysis of Variance. A generalized linear model with a logistic link function and a robust estimator was used to adjust for the EuroScore-II risk estimation. The incidence of the primary outcome increased in parallel with the quartiles of the 24-hour ABP in participants submitted to CABG: 10% in the first quartile, 13% in the second, 37% in the third, and 53% in the fourth quartile (P for trend<0.01). Quartiles of overnight ABP were also significantly associated with postoperative complications in patients undergoing CABG (P=0.04). The risks in CABG patients were independent of the EuroScore-II. There was no association between BP and outcomes in patients submitted to other surgeries. High preoperative BP measured by ABP monitoring is a risk factor for postoperative complications in patients submitted to CABG.

Surgical management of tension pneumomediastinum in mechanically ventilated coronavirus disease 2019 patients

Tension pneumomediastinum is an increasingly common condition since the COVID-19 pandemic's onset. It is a life-threatening complication with severe hemodynamic instability that is refractory to catecholamines. Surgical decompression with drainage is the key point of treatment. Various surgical procedures are reported in the literature, but no cohesive approach has yet been developed. The aim was to present the available options for surgical treatment of tension pneumomediastinum, as well as the post-interventional results. Nine cervical mediastinotomies were performed on intensive-care unit (ICU) patients who developed a tension pneumomediastinum during mechanical ventilation. The age and sex of patients, surgical complications, pre- and post-intervention basic hemodynamic parameters, as well as oxygen saturation levels, were recorded and analyzed. The mean age of patients was 62±16 years (6 males and 3 females). No postoperative surgical complications were recorded. The average preoperative systolic blood pressure was 91±12mmHg, the heart rate was 104±8bpm, and the oxygen saturation level was 89±6%, while the short-term postoperative values changed to 105±6mmHg, 101±4bpm, and 94±5%, respectively. There was no long-term survival benefit, with a mortality rate of 100%. Cervical mediastinotomy is the operative method of choice in the presence of tension pneumomediastinum allowing an effective decompression of the mediastinal structures and improving the condition of the affected patients without improving the survival rate.

Influence of Body Mass Index (BMI) and Blood Pressure (BP) on Deep Brain Stimulation (DBS) Outcomes in Parkinson’s disease (PD) Patients (P4-11.003)

<h3>Objective:</h3> PD literature supports a complex relationship between preoperative obesity, BP abnormalities, and post-DBS cognitive and motor outcomes. This study aims to improve on evidence associating BMI and BP with cognitive, emotional, and quality-of-life outcomes post-DBS. <h3>Background:</h3> Previous studies indicate obesity and hypertension increase intra-/ post-operative complications. Up to 65% of PD patients may be overweight or obese, with obese patients having less axial motor improvement and worsened cognitive function six months post-DBS. PD patients have also demonstrated increased BP fluctuations compared to healthy controls. <h3>Design/Methods:</h3> PD patients [n=28, Mage=62.6(8.8), 75% male, Medu=16.1(3.0), 92.9% STN) underwent pre-/post-DBS assessment (global cognition, language, memory, attention, processing speed, visuospatial ability) and emotional screenings via TeleNP. Systolic (M=130.0; SD=19.5) and diastolic (M=74.4; SD=16.0) BP (SBP, DBP), weight, and height were measured pre-DBS surgery. BMI was computed (M=27.3; SD=6.1). Logistic regression was used to predict neurocognitive performance using BMI, SBP, and DBP. <h3>Results:</h3> BMI, SBP, and DBP predicted decline in verbal reasoning in post-, compared to pre-, DBS testing, but not other assessed domains. Model coefficient estimates of 0.40 [<i>p</i>=.02, OR=1.5 (95% CI [1.07, 2.10])] for BMI, 0.13 [<i>p</i>=.04, OR=1.13 (95% CI [1.01, 1.28])] for SBP, and −0.15 [<i>p</i>=.08, OR=0.86 (95% CI [0.73, 1.02])] for DBP were indicated. Model fit was robust [X²(3)=14.2, <i>p</i>=.003]. While holding BP constant: each unit increase in BMI predicted a 50% increase in odds of verbal reasoning decline (one-half <i>SD</i> or more), and a unit increase in SBP (or decrease in DBP) predicted a 13% increase in odds (or, respectively, a 14% decrease in odds) of verbal reasoning decline. Post-DBS patient classification using BMI and BP predictors yield a .882 specificity and a .857 sensitivity. <h3>Conclusions:</h3> BMI, SBP, and DBP should be considered in predicting DBS surgical outcomes, particularly on verbal reasoning tasks. This small sample requires replication but is consistent with existing literature. <b>Disclosure:</b> Miss See has nothing to disclose. Dr. Harcourt has nothing to disclose. Annelly Buré-Reyes has nothing to disclose. Dr. Rodriguez has nothing to disclose. Dr. Luca has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Boston Scientific. Dr. Luca has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Signant Health. Jonathan Jagid has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Medtronic Inc. The institution of Jonathan Jagid has received research support from Boston Scientific. The institution of Jonathan Jagid has received research support from Medtronic Inc. Bonnie Levin has nothing to disclose. Ms. Bullock has nothing to disclose. The institution of Dr. Haq has received research support from NINDS. The institution of Dr. Haq has received research support from the Parkinson’s Foundation. The institution of Dr. Haq has received research support from NIMH. Dr. Haq has a non-compensated relationship as a consultant with Medtronics that is relevant to AAN interests or activities. Dr. Haq has a non-compensated relationship as a consultant with Boston Scientific that is relevant to AAN interests or activities. Dr. Haq has a non-compensated relationship as a consultant with Abbott that is relevant to AAN interests or activities. Dr. Sarno has nothing to disclose.

Blood pressure and renal outcomes after renal artery aneurysm intervention: Single-center experience and review of literature.

To explore the results of hypertension improvement and renal function preservation after renal artery aneurysm (RAA) repair. This study retrospectively analyzed the change in blood pressure (BP) and renal outcomes of 59 RAA patients throughout either open or endovascular operations and follow-up at a large center. Patients were grouped according to the difference in their BP at the last follow-up vs. their baseline value. Logistic regression was conducted to explore risk factors for perioperative BP relief and long-term hypertension reonset. Previous studies of RAA with records of BP, blood creatinine level, or GFR/eGFR results are reviewed. Hypertension was observed in 62.7% (37/59) of the patients included. Postoperative BP declined from 132.20 ± 16.46/79.92 ± 9.64 mmHg to 122.41 ± 11.17/71.10 ± 9.82 mmHg, while eGFR changed from 108.17 ± 24.73 to 98.92 ± 23.87 ml/min/1.73 m2. The median follow-up was 854 [IQR: 1,405] days. Both open and endovascular techniques significantly relieved hypertension and did not impair renal function much. Lower preoperative systolic BP (SBP) was significantly associated with hypertension relief (OR = 0.83, 95% CI: 0.70-0.99). Among patients with normal BP after the operation, higher postoperative SBP was significantly associated with new-onset hypertension (OR = 1.14, 95% CI: 1.01-1.29). Literature review indicated that renal function usually remained normal at follow-up, whereas relief of hypertension varied. Patients with lower preoperative SBP were likely to benefit more from the operation, while higher postoperative SBP indicated a higher chance of hypertension reonset. Creatinine level and eGFR generally remained stable regardless of operation type.

Does the routine skin only closure in ruptured Abdominal Aortic Aneurysm repair safely diminish abdominal compartment syndrome? A hypothesis generating retrospective study.

Abdominal compartment syndrome (ACS) often complicates ruptured abdominal aortic aneurysm (rAAA) repair. We aim to report results with routine skin-only abdominal wound closure after rAAA surgical repair. Single center, retrospective study including consecutive patients undergoing rAAA surgical repair during 7-years. Skin-only closure was routinely performed and if possible, secondary abdominal closure was performed during the same admission. Demographic information, preoperative hemodynamic condition of patients, perioperative information such as ACS, mortality and rate of abdominal closure and postoperative information were collected. During the study period 93 rAAAs were recorded. Ten patients were too frail to undergo repair or refused treatment. Eighty-three patients underwent immediate surgical repair. Mean age was 72.4±10.5 years and the vast majority were male (82:1). Preoperative systolic blood pressure <90mmHg was recorded in 31 patients. Intra-operative mortality was recorded in 9 cases. Overall in-hospital mortality was 34.9% (29/83). Primary fascial closure was performed in 5 patients, while skin-only closure was performed in 69. ACS was recorded in two cases in whom skin sutures were removed and negative pressure wound treatment was applied. Secondary fascial closure was feasible in 30 patients during the same admission. Among 37 patients not undergoing fascial closure, 18 died and 19 survived and were discharged with a planned ventral hernia. Median length of ICU and hospital stay were 5(1-24) and 13(8-35) days, respectively. After a mean follow-up of 21 months, telephone contact was possible with 14/19 patients that left the hospital with an abdominal hernia. Three reported hernia-related complications mandating surgical repair, while in 11 this was well tolerated. Routine skin-only closure during rAAA surgical repair results in low rates of ACS at the expense of a high rate of patients being discharged with a planned ventral hernia which, however, seems to be well tolerated by the majority of patients.

MP74-19 THE PREOPERATIVE DYSLIPIDEMIA AND HIGH OVERACTIVE BLADDER SYMPTOM SCORE PREDICT DE NOVO OVERACTIVE BLADDER AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY

You have accessJournal of UrologyCME1 Apr 2023MP74-19 THE PREOPERATIVE DYSLIPIDEMIA AND HIGH OVERACTIVE BLADDER SYMPTOM SCORE PREDICT DE NOVO OVERACTIVE BLADDER AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY Hitomi Imai, Hidenori Akaihata, Yuki Harigane, Kei Yaginuma, Yu Endo, Yuki Yoshida, Yuta Matsuoka, Akifumi Onagi, Kanako Matsuoka, Seiji Hoshi, Tomoyuki Koguchi, Junya Hata, Yuichi Sato, Masao Kataoka, and Yoshiyuki Kojima Hitomi ImaiHitomi Imai More articles by this author , Hidenori AkaihataHidenori Akaihata More articles by this author , Yuki HariganeYuki Harigane More articles by this author , Kei YaginumaKei Yaginuma More articles by this author , Yu EndoYu Endo More articles by this author , Yuki YoshidaYuki Yoshida More articles by this author , Yuta MatsuokaYuta Matsuoka More articles by this author , Akifumi OnagiAkifumi Onagi More articles by this author , Kanako MatsuokaKanako Matsuoka More articles by this author , Seiji HoshiSeiji Hoshi More articles by this author , Tomoyuki KoguchiTomoyuki Koguchi More articles by this author , Junya HataJunya Hata More articles by this author , Yuichi SatoYuichi Sato More articles by this author , Masao KataokaMasao Kataoka More articles by this author , and Yoshiyuki KojimaYoshiyuki Kojima More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003348.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Some patients have de novo overactive bladder (de novo OAB) after robot-assisted radical prostatectomy (RARP). It is possible that the preoperative characteristics of the patient contribute to onset of de novo OAB after RARP. The aim of this study is to determine whether the preoperative characteristics of the patients affect the de novo OAB after RARP. METHODS: Patients without OAB who underwent RARP for localized prostate cancer at our hospital between February 2013 and October 2020 were included in this study. At 12 months after RARP, these patients were divided into the OAB-free group and de novo OAB group according to absence or presence of OAB. The preoperative age, blood pressure, obesity (BMI≥25 kg/m2), dyslipidemia (LDL-C/HDL-C ratio ≥2.5), HbA1c, uroflowmetry parameter, prostate volume (PV) and overactive bladder symptom score (OABSS) were compared between the OAB-free group and de novo OAB group. RESULTS: A total of 404 patients (67.0±5.3 years) entered the study (OAB-free group: 338 patients, de novo OAB group: 66 patients). The percentage of patients with dyslipidemia was significantly higher in the de novo OAB group than in the OAB-free group (OAB-free group vs de novo OAB group: 32.0% vs 45.5%, p=0.04). The total OABSS was significantly higher in the de novo OAB group than in the OAB-free group (OAB-free group vs de novo OAB group: 2.1±1.4 points vs 3.2±1.6 points, p<0.01). The other preoperative characteristics of the patients were not significant differences between two groups. CONCLUSIONS: We demonstrated that preoperative dyslipidemia, which was defined as LDL-C/HDL-C ratio ≥2.5 in this study, and high OABSS contributed to de novo OAB after RARP. Recent studies have demonstrated that dyslipidemia contributes to the lower urinary tract dysfunction. Several studies have also reported that elevated LDL-C/HDL-C ratio is associated with progression of atherosclerosis1). The atherosclerosis is well known to cause OAB by chronic bladder ischemia. The preoperative elevated LDL-C/HDL-C ratio may cause de novo OAB after RARP through chronic bladder ischemia. The patients with preoperative high OABSS might have bladder instability although they were not diagnosed as OAB. The bladder instability might become worse after RARP, resulting in de novo OAB. The preoperative dyslipidemia and high OABSS may be useful marker of de novo OAB after RARP. Source of Funding: 1) Noike H, et al: Relationships between intravascular ultrasonographic findings and coronary risk factors in patients with normal coronary angiography. J Cardiol. 2005;45:1-10 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1078 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hitomi Imai More articles by this author Hidenori Akaihata More articles by this author Yuki Harigane More articles by this author Kei Yaginuma More articles by this author Yu Endo More articles by this author Yuki Yoshida More articles by this author Yuta Matsuoka More articles by this author Akifumi Onagi More articles by this author Kanako Matsuoka More articles by this author Seiji Hoshi More articles by this author Tomoyuki Koguchi More articles by this author Junya Hata More articles by this author Yuichi Sato More articles by this author Masao Kataoka More articles by this author Yoshiyuki Kojima More articles by this author Expand All Advertisement PDF downloadLoading ...

PD03-07 PREDICTORS OF SUCCESSFUL OUTCOME AFTER ADRENALECTOMY FOR UNILATERAL PRIMARY ALDOSTERONISM (UPA)

You have accessJournal of UrologyCME1 Apr 2023PD03-07 PREDICTORS OF SUCCESSFUL OUTCOME AFTER ADRENALECTOMY FOR UNILATERAL PRIMARY ALDOSTERONISM (UPA) Ahmed Saadi, Mohamed Ali Bedoui, Selim Zaghbib, Seif Mokaddem, Ibtissem Ben Nacef, Hamza Boussaffa, Haroun Ayed, Amine Derouiche, Karima Khiari, Marouene Chakroun, and Riadh Ben Slama Ahmed SaadiAhmed Saadi More articles by this author , Mohamed Ali BedouiMohamed Ali Bedoui More articles by this author , Selim ZaghbibSelim Zaghbib More articles by this author , Seif MokaddemSeif Mokaddem More articles by this author , Ibtissem Ben NacefIbtissem Ben Nacef More articles by this author , Hamza BoussaffaHamza Boussaffa More articles by this author , Haroun AyedHaroun Ayed More articles by this author , Amine DerouicheAmine Derouiche More articles by this author , Karima KhiariKarima Khiari More articles by this author , Marouene ChakrounMarouene Chakroun More articles by this author , and Riadh Ben SlamaRiadh Ben Slama More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003220.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: UPA is the most common surgically curable form of endocrine hypertension. The underlying cause of resistant hypertension after surgery remains controversial. The aim of this study was to identify preoperative factors predictive of complete clinical success after laparoscopic adrenalectomy for UPA. METHODS: Between 2000 and 2021 patients treated by laparoscopic adrenalectomy for UPA were enrolled in this retrospective study. Preoperative data were divided into 3 categories: clinical, biological and radiological variables and follow up data was recorded. For determining factors influencing surgical outcome patients were divided into 3 groups: 1) complete clinical success (CS): normal blood pressure(BP) (≤140/90 mmHg) without antihypertensive medications (AHM). 2) Partial CS: the same BP as before surgery with less AHM or a reduction in BP with either the same amount or less AHM. 3) Absent CS: unchanged or increased BP with either the same amount or an increase in AHM. We performed an univariate and multivariate regression analysis. Statistical significance was defined as a P value of <0.05. RESULTS: Our study included 71 patients (59% female, mean age 46 years, median follow up 21 months). The mean duration of hypertension before surgery was 82.9±75.9 months. Preoperative mean DDD was 2.8±1.1 with 66% of patients having poorly controlled hypertension. Retroperitoneoscopic adrenalectomy was performed in 47 patients (66%). Four patients (6%) underwent partial adrenalectomy. Only 2 patients required conversion to open adrenalectomy. Complication rate (Clavien-Dindo ≥3a) was 4%. No mortality was registered. After adrenalectomy complete plus partial CS occured in 64 patients (91%).The following factors were associated with a complete clinical success by univariate analysis : absence of diabetes (p=0.007), low BMI (p=0.001), lower levels of preoperative AHM (p=0.01), controlled preoperative BP (p=0.024), higher levels of plasma aldosterone-to-renin ratio (ARR) (p=0.001), adenoma classification (p<0.001) and aldosteronoma resolution score (ARS) (p=0.002). Multivariate regression analysis revealed that the main determinants of complete clinical success were : absence of diabetes (OR: 5.205, 95% CI 1.411-19.206), low BMI (OR: 0.904, 95% CI 0.820-0.997), plasma ARR >332 (OR: 1.003, 95% CI 1.001-1.004) and ARS score ≥3 (OR: 2.056, 95% CI 1.210-3.491). CONCLUSIONS: The majority of our patients (91%) experienced clinical benefit from adrenalectomy.The main determinants of cured hypertension were absence of diabetes, low BMI, high levels of plasma ARR and high ARS score. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e77 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ahmed Saadi More articles by this author Mohamed Ali Bedoui More articles by this author Selim Zaghbib More articles by this author Seif Mokaddem More articles by this author Ibtissem Ben Nacef More articles by this author Hamza Boussaffa More articles by this author Haroun Ayed More articles by this author Amine Derouiche More articles by this author Karima Khiari More articles by this author Marouene Chakroun More articles by this author Riadh Ben Slama More articles by this author Expand All Advertisement PDF downloadLoading ...

Variability of blood pressure and risk of postoperative acute kidney injury in patients undergoing surgery for acute aortic dissection: A 11-year single-center study.

In patients receiving surgery, increased blood pressure variability may contribute to the onset of acute kidney injury (AKI). However, the extent and significance of blood pressure variability in patients undergoing aortic dissection surgery have yet to be determined. The authors analyzed all patients operated for aortic dissection at Peking University Shenzhen Hospital from January 1, 2011 to December 31, 2021. Preoperative blood pressure variability was expressed as standard deviation, coefficient of variation (CV), and range. The primary outcome was postoperative AKI. After multivariate analysis, systolic blood pressure variability was found to be independently associated with AKI after aortic dissection surgery. The odds ratios and 95% confidence intervals for standard deviation, CV, and systolic blood pressure range were 1.232 (1.011-1.500), 1.451 (1.058-1.991), and 1.138 (0.986-1.288) for postoperative AKI, respectively. However, there was no significant relationship between diastolic blood pressure variability and AKI after aortic dissection surgery. Finally, in patients undergoing surgery for aortic dissection, the variability of systolic blood pressure is actually an important factor in the development of AKI.

Influencing factors of dexmedetomidine on postoperative myocardial protection in patients with Video-Assisted Thoracoscopic Surgery lobectomy: A retrospective cohort study.

To investigate factors affecting the cardioprotective proprieties of dexmedetomidine in patients after pulmonary lobectomy. The data of 504 patients who received dexmedetomidine combined with general anesthesia and video-assisted thoracoscopic surgery (VATS) lobectomy in Shanghai Lung Hospital from April 2018 to April 2019 were analyzed retrospectively. Patients were divided into normal troponin group (LTG) and high troponin group (HTG) according to whether the postoperative troponin level was greater than 13. Ratio of systolic blood pressure greater than 180, heart rate greater than 110, the dose of dopamine and other drugs, the ratio of neutrophils to lymphocytes, postoperative visual analog scale (VAS) pain score and hospital stay were compared between the two groups. Preoperative systolic blood pressure, intraoperative maximum systolic blood pressure, intraoperative maximum heart rate, intraoperative minimum heart rate and N-terminal pro hormone brain natriuretic peptide (NT-proBNP) correlated with troponin values. The proportion of patients with systolic blood pressure greater than 180 in the HTG was higher than that in the LTG (p=0.0068), and the proportion of patients with heart rate greater than 110 was significantly higher in the HTG compared to the LTG (p=0.044). The ratio of neutrophils/lymphocytes in the LTG was lower than that in the HTG (P<0.001). At 24 and 48 hours after operation, the VAS score in the LTG was lower than that in the HTG. Patients with high troponin had longer hospital stay. Intraoperative systolic blood pressure, maximum heart rate, and postoperative neutrophil/lymphocyte ratio are important factors that affect the myocardial protection properties of dexmedetomidine and may affect the postoperative analgesia effect and the length of hospital stay.

Interventional treatment and early-stage follow-up of pulmonary atresia with intact ventricular septum

Objective: To explore the application value of percutaneous peripheral interventional therapy in pulmonary atresia with intact ventricular septal (PA-IVS). Methods: Retrospective case summary. The data was collected from 25 children who were hospitalized at the Children's Hospital,Zhejiang University School of Medicine from August 2019 to August 2022, had been diagnosed with PA-IVS by echocardiography, and underwent interventional treatment. The sex, age, weight, operation time, radiation exposure time, and radiation dose of the patients were collected. The patients were divided into the arterial duct stenting group and the non-stenting group. Preoperative tricuspid annular diameters and Z scores, right ventricular length diameters, and right ventricular/left ventricular length-diameter ratios were compared by paired t-tests. Right ventricular systolic pressure difference, oxygen saturation, lactic acid before and after the surgery were compared for 24 children who received percutaneous balloon pulmonary valvuloplasty. Right ventricular improvement in 25 children after operation was analyzed. The correlation between postoperative oxygen saturation and postoperative right ventricular systolic blood pressure difference, the degree of pulmonary valve opening and the Z value of tricuspid valve ring in the non-stenting group were analyzed. Results: A total of 25 patients with PA-IVS were enrolled in the study, of whom 19 were males and 6 females, with an age at surgery of 12 (6, 28) days and a weight of (3.7±0.5) kg. One of them underwent only stenting of the arterial duct; 20 children underwent only percutaneous pulmonary valve perforation and balloon angioplasty; 4 children underwent both procedures. The Z-value of the tricuspid ring was -1.5±1.2 in the group with arterial duct stenting, and -0.1±0.4 in the group without stenting (t=2.77, P=0.010). The tricuspid regurgitant flow rate 1 month after surgery was significantly lower than the preoperative ((3.4±0.6) vs. (4.8±0.9) m/s, t=6.62,P<0.001). In the 24 children with percutaneous pulmonary valve perforation and balloon angioplasty, the preoperative right ventricular systolic blood pressure was (110±32) mmHg, and the postoperative systolic blood pressure was (52±19) mmHg (1 mmHg=0.133 kPa) (F=59.55, P<0.001). The factors that may affect postoperative oxygen saturation in 20 cases of non-stenting group were analyzed. The results suggested that the pre and post-operative right ventricular systolic blood pressure differences (r=-0.11, P=0.649), and the pulmonary valve orifice opening (r=-0.31, P=0.201) and tricuspid annulus Z value (r=-0.18, P=0.452) at 1 month after the operation were not significantly correlated with the postoperative oxygen saturation. Conclusions: Interventional therapy can be used as the first choice for one-stage operation of PA-IVS. Percutaneous pulmonary valve perforation and balloon angioplasty are more suitable for children with well-developed right ventricles, tricuspid annulus, and pulmonary arteries. While the smaller the tricuspid annulus, the more dependent it is on the ductus arteriosus and thus patients are more suitable for arterial duct stenting.