Korean J Anesthesiol.  2019 Dec;72(6):599-605. 10.4097/kja.19220.

Prediction of early postoperative desaturation in extreme older patients after spinal anesthesia for femur fracture surgery: a retrospective analysis

• Jo YY
• Park CG
• Lee JY
• Kwon SK
• Kwak HJ

• KMID: 2465730
• DOI: http://doi.org/10.4097/kja.19220

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 (PaOâ‚‚/FiOâ‚‚ 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 PaOâ‚‚/FiOâ‚‚ 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.

Keyword

Arterial blood gas analysis; Femur neck fracture; Frail older individuals; Postoperative hypoxia; Spinal anesthesia; Spirometry

MeSH Terms

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
Oxygen