Inferior vena cava collapsibility index and caval aorta index as predictor of hypotension after spinal anesthesia in elderly population

Q: What are the key findings of this study?

Preoperative IVC-CI (OR 1.07, p<0.001) and IVC/Ao index (OR 5.11, p=0.026) independently predicted post-spinal anesthesia hypotension, with a combined AUC of 0.798.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Post-spinal anesthesia hypotension (n=96). Intervention: Preoperative inferior vena cava collapsibility index (IVC-CI) and inferior vena cava to aorta (IVC/Ao) index vs. Patients who did not develop post-spinal anesthesia hypotension. Primary outcome: Post-spinal anesthesia hypotension (SBP <90 mmHg, SBP decrease ≥30% from baseline, or MAP <60 mmHg within 30 minutes) predicted by IVC-CI (%) (OR 1.07, 95% CI 1.03-1.10, p=<0.001).

Q: What does this research mean for the field?

Preoperative inferior vena cava collapsibility index and inferior vena cava to aorta index independently predict post-spinal anesthesia hypotension in elderly patients, with their combination providing superior predictive accuracy. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate preoperative ultrasound measurements of the inferior vena cava collapsibility index and the inferior vena cava to aorta index for predicting post-spinal anesthesia hypotension in patients aged 50 years and older.

Nirali Nimesh Panchal; Harsh Shah; Jagdish Asnani; Bhumika Pathak; Jishmi K Shah

doi:10.18231/j.ijca.19440.1791622922

October 22, 2026Indian Journal of Clinical AnaesthesiaOpen Access

Inferior vena cava collapsibility index and caval aorta index as predictor of hypotension after spinal anesthesia in elderly population

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Key result

Preoperative IVC collapsibility index is linked to ~7% higher odds of post-spinal anesthesia hypotension.

OR 1.07
95% CI 1.03-1.10
P<0.001
n=96

Why the study?

Post-spinal anesthesia hypotension (PSAH) is frequent in elderly patients, but evidence supporting the inferior vena cava collapsibility index (IVC-CI) and inferior vena cava/aorta (IVC/Ao) index as predictors of PSAH in this population remains limited.

Does preoperative ultrasound measurement of inferior vena cava collapsibility index (IVC-CI) and inferior vena cava to aorta (IVC/Ao) index predict post-spinal anesthesia hypotension in patients aged 50 years and above undergoing elective surgery?

Key Points

To evaluate preoperative ultrasound measurements of the inferior vena cava collapsibility index and the inferior vena cava to aorta index for predicting post-spinal anesthesia hypotension in patients aged 50 years and older.
Prospective observational study conducted in 96 patients aged ≥50 years undergoing elective surgery under spinal anesthesia at a tertiary care hospital.
Preoperative ultrasound was performed to measure the inferior vena cava collapsibility index (IVC-CI) and inferior vena cava/aorta (IVC/Ao) index.
Multivariable logistic regression and receiver operating characteristic (ROC) analyses assessed independent predictors and predictive performance.
Post-spinal anesthesia hypotension occurred in 51% of patients (49/96), who had higher mean IVC-CI (46.96%±15.87 vs. 29.82%±17.61, p < 0.001) and IVC/Ao index (1.09±0.47 vs. 0.92±0.25, p = 0.028).
ROC analysis showed an AUC of 0.774 for IVC-CI (cut-off 44.9%, sensitivity 69.4%, specificity 80.9%) and an AUC of 0.620 for IVC/Ao index, while their combination achieved an AUC of 0.798 (sensitivity 73.5%, specificity 83.0%).
Multivariable analysis identified IVC-CI (OR: 1.07, p < 0.001; OR: 1.88 per 10-percentage-point increase, 95% CI: 1.36–2.61) and IVC/Ao index (OR: 5.11, 95% CI: 1.22–21.43, p = 0.026) as independent predictors of hypotension.

Study Design

Type

Observational (n=96)

Blinding

Single-blind

Multicenter

No

Structured PICO

Does preoperative ultrasound measurement of inferior vena cava collapsibility index (IVC-CI) and inferior vena cava to aorta (IVC/Ao) index predict post-spinal anesthesia hypotension in patients aged 50 years and above undergoing elective surgery?

P

Population

96 surgical patients aged 50-86 years (mean age 62.42 years, 27.08% female) with ASA physical status II or III undergoing elective surgery under spinal anesthesia, excluding those with LVEF <40%, BMI >30 kg/m2, or baseline hypotension, observed for 30 minutes post-anesthesia.

E

Exposure

Preoperative point-of-care ultrasonography (using a portable ultrasound system with a 1-5 MHz cardiac probe in abdominal mode) to measure inferior vena cava collapsibility index (IVC-CI) in the subcostal long-axis view and inferior vena cava to aorta (IVC/Ao) index prior to spinal anesthesia.

O

Outcome

Post-spinal anesthesia hypotension (PSAH) during the first 30 minutes following spinal anesthesia, defined as the occurrence of any one of the following: systolic blood pressure (SBP) <90 mmHg, a decrease in SBP of ≥30% from baseline, or a mean arterial pressure (MAP) <60 mmHg (measured at baseline and at 5-minute intervals for 30 minutes).surrogate

Main Result

Odds Ratio: 1.07 (95% CI 1.03–1.1)

Absolute Event Rate: 46.96% vs 29.82%

p-value: p=<0.001

Limitations

Single-center study with a limited sample size affecting generalizability
Hemodynamic assessment was restricted to the first 30 minutes following spinal anesthesia
Combined predictive model was developed and assessed within the same cohort without independent external validation, risking overfitting
Ultrasound measurements are inherently operator-dependent
Potential for residual confounding
Single center study with a limited sample size, potentially affecting generalizability
The combined model was developed and assessed within the same cohort and may be subject to optimism and overfitting

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Implication

Preoperative ultrasound assessment of inferior vena cava collapsibility index (IVC-CI) and inferior vena cava-to-aorta (IVC/Ao) index independently predicts post-spinal anesthesia hypotension in patients aged 50 and older, with their combined use offering improved risk stratification (AUC 0.798).

Abstract

Background: Post-spinal anesthesia hypotension (PSAH) is frequent in elderly patients and associated with impaired perfusion and perioperative outcomes. Inferior vena cava collapsibility index (IVC-CI) and inferior vena cava/aorta (IVC/Ao) index have been proposed as predictors of PSAH, but evidence in elderly remains limited. This study evaluated the preoperative inferior vena cava collapsibility index and inferior vena cava to aorta index for predicting post-spinal anesthesia hypotension in patients aged 50 years and above.Materials and Methods: A prospective observational study was done among 96 patients aged ≥50 years undergoing elective surgery under spinal anesthesia at a tertiary care hospital. Preoperative ultrasound measurements of IVC-CI and IVC/Ao index were obtained. Multivariable logistic regression and receiver operating characteristic (ROC) curve analysis were performed to identify independent and to assess predictive performance.Results: PSAH occurred in 51% of patients. Patients who developed PSAH had significantly higher mean IVC-CI (46.96%±15.87 vs. 29.82%±17.61; p < 0.001) and IVC/Ao index (1.09±0.47 vs. 0.92±0.25; p = 0.028) compared to those without PSAH. ROC analysis showed IVC-CI had good discriminatory ability (AUC 0.774) with optimal cut-off of 44.9% (sensitivity 69.4%, specificity 80.9%), while IVC/Ao index had lower accuracy (AUC 0.620). A combined model incorporating both parameters demonstrated improved predictive performance (AUC: 0.798; sensitivity: 73.5%; specificity: 83.0%). Multivariable analysis identified both IVC-CI (OR: 1.07, p < 0.001) and IVC/Ao index (OR: 5.11, p=0.026) as independently associated with PSAH.Conclusion: The inferior vena cava collapsibility index and the inferior vena cava to aorta index independently predict post-spinal anesthesia hypotension in elderly patients. Combined use improves prediction. These indices may enhance preoperative risk stratification and individualized management, reducing the risk of hypotension after spinal anesthesia.

Discussion

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Cite This Study

Panchal et al. (2026) conducted an observational in Post-spinal anesthesia hypotension (n=96). Preoperative inferior vena cava collapsibility index (IVC-CI) and inferior vena cava to aorta (IVC/Ao) index vs. Patients who did not develop post-spinal anesthesia hypotension was evaluated on Post-spinal anesthesia hypotension (SBP <90 mmHg, SBP decrease ≥30% from baseline, or MAP <60 mmHg within 30 minutes) predicted by IVC-CI (%) (OR 1.07, 95% CI 1.03-1.10, p=<0.001). Preoperative IVC-CI (OR 1.07, p<0.001) and IVC/Ao index (OR 5.11, p=0.026) independently predicted post-spinal anesthesia hypotension, with a combined AUC of 0.798.

synapsesocial.com/papers/6aee6b8671a7594806220a1e https://doi.org/10.18231/j.ijca.19440.1791622922

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Inferior vena cava collapsibility index and caval aorta index as predictor of hypotension after spinal anesthesia in elderly population

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Inferior vena cava collapsibility index and caval aorta index as predictor of hypotension after spinal anesthesia in elderly population

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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