Incidence of orthostatic hypotension and cardiovascular response to postoperative early mobilization in patients undergoing cardiothoracic and abdominal surgery

Masatoshi Hanada, Yuichi Tawara, Takuro Miyazaki, Shuntaro Sato, Yosuke Morimoto, Masato Oikawa, Hiroshi Niwa, Kiyoyuki Eishi, Takeshi Nagayasu, Susumu Eguchi, Ryo Kozu, Masatoshi Hanada, Yuichi Tawara, Takuro Miyazaki, Shuntaro Sato, Yosuke Morimoto, Masato Oikawa, Hiroshi Niwa, Kiyoyuki Eishi, Takeshi Nagayasu, Susumu Eguchi, Ryo Kozu

Abstract

Background: In cardiothoracic and abdominal surgery, postoperative complications remain major clinical problems. Early mobilization has been widely practiced and is an important component in preventing complications, including orthostatic hypotension (OH) during postoperative management. We investigated cardiovascular response during early mobilization and the incidence of OH after cardiothoracic and abdominal surgery.

Methods: In this prospective observational study, we consecutively analyzed data from 495 patients who underwent elective cardiothoracic and abdominal surgery. We examined the incidence of OH, and the independent risk factors associated with OH during early mobilization after major surgery. Multivariate logistic regression was performed using various characteristics of patients to identify OH-related independent factors.

Results: OH was observed in 191 (39%) of 495 patients. The incidence of OH in cardiac, thoracic, and abdominal groups was 39 (33%) of 119, 95 (46%) of 208, and 57 (34%) of 168 patients, respectively. Male sex (OR 1.538; p = 0.03) and epidural anesthesia (OR 2.906; p < 0.001) were independently associated with OH on multivariate analysis.

Conclusions: These results demonstrate that approximately 40% patients experience OH during early mobilization after cardiothoracic and abdominal surgery. Sex was identified as an independent factor for OH during early mobilization after all three types of surgeries, while epidural anesthesia was only identified after thoracic surgery. Therefore, the frequent occurrence of OH during postoperative early mobilization should be recognized.

Trial registration: University hospital Medical Information Network Center (UMIN-CTR) number UMIN000018632 . (Registered on 1st October, 2008).

Keywords: Cardiothoracic and abdominal surgery; Cardiovascular responses; Early mobilization; Orthostatic hypotension.

Conflict of interest statement

Ethics approval and consent to participate

The Human Ethics Review Committee of Nagasaki University Hospital (Approval number: 09022760-2) and Seirei Mikatahara General Hospital (Approval number: 09-02) approved this study. Participants gave written informed consent for analysis and publication prior to the study scenario. This study was registered in UMIN-CTR (UMIN000018632).

Consent for publication

All authors have given final approval of the version to be published.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow of patients through the study
Fig. 2
Fig. 2
Comparison of the range of variation in cardiovascular response. a Systolic blood pressure, {b) diastolic blood pressure, (c) mean arterial pressure, (d) heart rate. OH; orthostatic hypotension
Fig. 3
Fig. 3
Incidence rate of OH and rate of discontinuation during postoperative mobilization

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