title: Perioperative cardiopulmonary complications after cervical spine surgery in the prone position: the relationship between age and preoperative testing.
abstract: BACKGROUND
  Cardiac arrest during spine surgery in the prone position is difficult to manage as poor access makes cardiopulmonary resuscitation and defibrillation difficult. Advanced age is the maximal risk factor for cardiac arrest. Therefore, we wanted to determine the relationship between age and cardiac risk factors/pre-operating tests for cervical spine surgery in the prone position.
  
  
  METHODS
  The inclusion criteria for this study specified 88 patients scheduled should undergo cervical spine surgery in the prone position. The patients were divided into two groups: Paients in group A (50 patients) were aged 69 and under, Group B (38 patients) 70 and above. All patients responded to a medical interview about eight cardiac risk factors including past history, chest symptoms, diabetes mellitus, hypertension, hyperlipidemia, obesity, smoking, and family history. All patients underwent physical examination and 24-h Holter ECG and echocardiography performed by two cardiologists before surgery. We analyzed relationships between cardiac risk factors and ECG/echocardiography and investigated intra- and postoperative cardiovascular complications.
  
  
  RESULTS
  Although there were no significant differences in the number of cardiac risk factors between the two groups, the frequency of hypertension was significantly greater in Group B than in Group A. The frequency of abnormal ECG and echocardiography findings especially was significantly greater in Group B than in Group A. In ECG and echocardiography, three patients in Group B who had no cardiac risk factors before surgery showed abnormal findings, and one of the three patients had the amalgamation of arrhythmia after the operation. Also, in Group B, cardiovascular complications occurred in one case during operation.
  
  
  CONCLUSIONS
  These results suggested that patients aged 70 and above should undergo ECG and echocardiography examination before cervical spine surgery in the prone position whether they have cardiac risk factors or not . A prospective, randomized multi-center study with a larger patient sample is warranted to ultimately demonstrate how patients should be tested before spine surgery in the prone position.
authors.affiliation: Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori 036-8562, Japan. gengen722@hotmail.com
authors.forename: Gentaro
authors.initials: G
authors.lastname: Kumagai
authors.forename: Kazunari
authors.initials: K
authors.lastname: Takeuchi
authors.forename: Shuichi
authors.initials: S
authors.lastname: Aburakawa
authors.forename: Toru
authors.initials: T
authors.lastname: Yokoyama
authors.forename: Atsushi
authors.initials: A
authors.lastname: Ono
authors.forename: Takuya
authors.initials: T
authors.lastname: Numasawa
authors.forename: Kanichiro
authors.initials: K
authors.lastname: Wada
authors.forename: Satoshi
authors.initials: S
authors.lastname: Toh
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation; D002574:Cervical Vertebrae / Q000503:physiopathology / Q000601:surgery*; D016009:Chi-Square Distribution; D015331:Cohort Studies; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D005260:Female; D006323:Heart Arrest / Q000517:prevention & control* / Q000628:therapy; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D016684:Prone Position; D012189:Retrospective Studies; D018570:Risk Assessment; D013122:Spinal Diseases / Q000175:diagnosis / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods; D015996:Survival Rate; D016896:Treatment Outcome