Prediction of early postoperative desaturation in extreme older patients after spinal anesthesia for femur fracture surgery: a retrospective analysis
- Author:
Youn Yi JO
1
;
Chun Gon PARK
;
Ji Yeon LEE
;
Sun Koo KWON
;
Hyun Jeong KWAK
Author Information
- Publication Type:Original Article
- Keywords: Arterial blood gas analysis; Femur neck fracture; Frail older individuals; Postoperative hypoxia; Spinal anesthesia; Spirometry
- MeSH: Anesthesia, Spinal; Blood Gas Analysis; Cardiovascular Diseases; Femoral Neck Fractures; Femur; Humans; Incidence; Intensive Care Units; Logistic Models; Medical Records; Oxygen; Partial Pressure; Retrospective Studies; Spirometry
- From:Korean Journal of Anesthesiology 2019;72(6):599-605
- CountryRepublic of Korea
- Language:English
- Abstract: BACKGROUND: Postoperative desaturation in older individuals is rarely addressed in the literature. The objective of this retrospective study was to investigate whether a preoperative spirometric test and arterial blood gas analysis (ABGA) might predict postoperative desaturation after spinal anesthesia in extreme older patients.METHODS: The medical records of 399 patients (age ≥ 80 yrs) who were administered spinal anesthesia for a femur neck fracture surgery were retrospectively reviewed. Early postoperative desaturation was defined as a reduction of oxygen saturation (SpO₂) below 90% within 3 days of surgery, despite O₂ supply via a nasal prong. Binary logistic regression analysis was used to identify predictors of early postoperative desaturation.RESULTS: The incidence of postoperative desaturation was 12.5%. Major morbidity rate was significantly higher in the desaturation group (n = 50) than that in the non-desaturation group (n = 349) (14% vs. 3.2%, P = 0.001) with more frequent postoperative stays in the intensive care unit (22% vs. 12%, P = 0.004). In a binary logistic regression analysis, preoperative ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO₂/FiO₂ ratio) (OR, 0.972; 95% CI 0.952–0.993; P = 0.010) and history of cardiovascular disease (OR, 2.127; 95% CI 1.004–4.507; P = 0.049) predicted postoperative desaturation.CONCLUSIONS: Preoperative PaO₂/FiO₂ ratio, but not preoperative spirometry, was predictive of the postoperative desaturation in older patients after being administered spinal anesthesia for femur fracture surgery. Based on our results, preoperative ABGA may be helpful in predicting early postoperative desaturation in these patients.
