Perioperative management of patients with severe pulmonary hypertension in major orthopedic surgery: experience-based recommendations.
BACKGROUND
It is known that pulmonary hypertension is associated with worse outcome in both cardiac and non-cardiac surgery. The aims of our retrospective analysis were to evaluate the outcomes of our patients with pulmonary hypertension undergoing major orthopedic surgery and to give experience-based recommendations for the perioperative management.


METHODS
From 92 patients with pulmonary hypertension undergoing different kinds of surgical procedures from 2011-2014 in a tertiary academic hospital we evaluated 16 patients with major orthopedic surgery for perioperative morbidity and mortality.


RESULTS
Regarding the in-hospital morbidity and mortality, one patient died postoperatively due to pulmonary infection and right heart failure (6.25%) and 6 patients suffered significant postoperative complications (37.5%; bleeding = 1, infection = 1, wound healing deficits = 3; dysrhythmia = 1).


CONCLUSIONS
Our data show that major orthopedic surgery is feasible with satisfactory outcome even in cases of severe pulmonary hypertension by an individualized, disease-adapted interdisciplinary treatment concept.
Medical Clinic and Polyclinic I, Department of Pneumology, Universitätsklinikum Leipzig AöR, Leipzig, Germany.
Hans-Jürgen
HJ
Seyfarth
Clinic for Anesthesiology, Critical Care Medicine and Pain Therapy, St. Georg Hospital Leipzig, Germany.
Jochen
J
Gille
Clinic for Anesthesiology, Critical Care Medicine and Pain Therapy, St. Georg Hospital Leipzig, Germany.
Armin
A
Sablotzki
Clinic for Anesthesiology, Critical Care Medicine and Pain Therapy, St. Georg Hospital Leipzig, Germany.
Stefan
S
Gerlach
Clinic for Anesthesiology, Critical Care Medicine and Pain Therapy, St. Georg Hospital Leipzig, Germany.
Michael
M
Malcharek
Clinic for Orthopedic and Reconstructive Surgery, St. Georg Hospital Leipzig, Germany.
Andreas
A
Gosse
Clinic for Orthopedic and Reconstructive Surgery, St. Georg Hospital Leipzig, Germany.
Ralf H
RH
Gahr
Clinic for Anesthesiology and Critical Care Medicine, Martin-Luther-University of Halle-Wittenberg, Halle/Saale, Germany.
Elke
E
Czeslick
general anesthesia; intraoperative monitoring; local anesthesia; perioperative management; pulmonary hypertension