Key result
Preoperative non-cardiac autonomic reactivity was associated with a significantly higher rate of postoperative complications compared to cardiac autonomic reactivity (63.3% vs 17.4%; p<0.01).
Why the study?
Does non-cardiac autonomic reactivity assessed by preoperative heart-rate variability predict postoperative complications in patients undergoing major abdominal surgery?
Observational (n=53)
No
Does non-cardiac autonomic reactivity assessed by preoperative heart-rate variability predict postoperative complications in patients undergoing major abdominal surgery?
Absolute Event Rate: 63.3% vs 17.4%
p-value: p=<0.01
Preoperative assessment of heart-rate variability during orthostatic load can identify patients with low autonomic reserves who are at high risk for postoperative complications after major abdominal surgery.
Preoperative non-cardiac autonomic reactivity may flag higher complication risk after abdominal surgery; leaves open need for prospective validation before practice change.
Background: Major abdominal surgery (MAS) is associated with increased morbidity and mortality. The main objective of our study was to evaluate the predictive value of heart-rate variability (HRV) concerning development of postoperative complications in patients undergoing MAS. The secondary objectives were to identify the relationship of HRV and use of vasoactive drugs during anesthesia, intensive care unit length of stay (ICU-LOS), and hospital length of stay (H-LOS). Patients and methods: Sixty-five patients scheduled for elective MAS were enrolled in a prospective, single-center, observational study. HRV was measured by spectral analysis (SA) preoperatively during orthostatic load. Patients were divided according to cardiac autonomic reactivity (CAR; n=23) and non-cardiac autonomic reactivity (NCAR; n=30). Results: The final analysis included 53 patients. No significant difference was observed between the two groups regarding type of surgery, use of minimally invasive techniques or epidural catheter, duration of surgery and anesthesia, or the amount of fluid administered intraoperatively. The NCAR group had significantly greater intraoperative blood loss than the CAR group (541.7±541.9 mL vs 269.6±174.3 mL, p <0.05). In the NCAR group, vasoactive drugs were used during anesthesia more frequently (n=21 vs n=4; p <0.001), and more patients had at least one postoperative complication compared to the CAR group (n=19 vs n=4; p <0.01). Furthermore, the NCAR group had more serious complications (Clavien–Dindo ≥ Grade III n=6 vs n=0; p <0.05) and a greater number of complications than the CAR group (n=57 vs n=5; p <0.001). Significant differences were found for two specific subgroups of complications: hypotension requiring vasoactive drugs (NCAR: n=10 vs CAR: n=0; p <0.01) and ileus (NCAR: n=11 vs CAR: n=2; p <0.05). Moreover, significant differences were found in the ICU-LOS (NCAR: 5.7±3.5 days vs CAR: 2.6±0.7 days; p <0.0001) and H-LOS (NCAR: 12.2±5.6 days vs CAR: 7.2±1.7 days; p <0.0001). Conclusion: Preoperative HRV assessment during orthostatic load is objective and useful for identifying patients with low autonomic physiological reserves and high risk of poor postoperative course.
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Reimer et al. (2017) conducted an observational in Major abdominal surgery (n=53). Non-cardiac autonomic reactivity (NCAR) vs. Cardiac autonomic reactivity (CAR) was evaluated on Development of postoperative complications (p=<0.01). Preoperative non-cardiac autonomic reactivity was associated with a significantly higher rate of postoperative complications compared to cardiac autonomic reactivity (63.3% vs 17.4%; p<0.01).
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