Neuroanesthesia & neurocritical care
The Association Between Fluid Management and Intraoperative Blood Pressure and Patients’ Outcome After Complex Spine Surgeries
Authors' conclusion
We discovered a change point in net fluid administration of 1,865mL. Above this change point, higher net fluid administration is associated with increased odds of developing postoperative complications. Intraoperative hypotension in complex spine surgeries was associated with increased postoperative complications.
Study context
- Population
- Patients undergoing complex spine surgery at the Cleveland Clinic Foundation, 2012–20226,998 surgical cases
- Participants
- 6,243 patients
- Exposure
- Intraoperative net fluid administration and intraoperative hypotension vs postoperative complications
- Outcome
- Collapsed composite of postoperative complications (acute kidney injury (AKI), myocardial infarction (MI), stroke, intensive care unit (ICU) admission)
Methodological detailssingle-centre
- Single-centre
Main finding
As reported in the abstract
Composite:
- Postoperative complications by net fluid administration
- Intraoperative hypotension
- Change point in net fluid administration
- 1865 mL (95% CI 1228 to 4710 mL)
- OR per 500 mL increase in net fluid above the change point
- 1.16 (95% CI 1.11-1.21; P < .0001)
- OR per 500 mL increase in net fluid below the change point
- 0.87 (95% CI 0.77-0.98; P = .026)
- Intraoperative hypotension detected, n (29%) of surgeries
- 2052
- OR for any postoperative complication with intraoperative hypotension
- 1.57 (95% CI 1.37-1.80; P < .0001)
Observational data: associations, not effects.
Secondary outcomes
Postoperative pulmonary complications
- OR per 500 mL increase in net fluid
- 1.12 (95% CI 1.07-1.18; P < .0001)
- OR with intraoperative hypotension
- 1.30 (95% CI 1.04-1.61; P = .019)
Original publication
The Association Between Fluid Management and Intraoperative Blood Pressure and Patients’ Outcome After Complex Spine Surgeries. Anesth Analg. Published 1 May 2025. doi:10.
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