title: Effects of preoperative chronic hypoxemia on geriatrics outcomes after hip arthroplasty: A hospital-based retrospective analysis study.
abstract: The partial pressure of oxygen decreases as altitude increases, the preoperative chronic hypoxemia (CH) may have a plausible clinical impact. Risk factors for postoperative serious adverse events (pSAEs) in patients living in high altitudes during primary hip arthroplasty (HA) are not clear.This is an observational study embracing patients from January 1, 2011 to December 31, 2015 at Yan'an Hospital of Kunming City, a 1338-bed municipal teaching hospital of Kunming Medical University. Univariate analysis revealed that significant differences between patients with and without preoperative CH occurred in intraoperative hypotension (77 [33%] vs 34 [47%], P = .040) and that significant differences between patients with and without pSAEs occurred in following variables: preoperative CH (32 [57%] vs 199 [80%], P < .001), intraoperative hypotension (37 [66%] vs 74 [30%], P < .001), highest noradrenaline support (.09 [.01-.21] vs .03 [.01-.05] μg/kg/min, P < .001), higher application of general anesthesia (15 [27%] vs 29 [12%], P = .004), and lower of combined-spinal epidural anesthesia (CSEA) (21 [37%] vs 165 [66%], P < .001). The general anesthesia and intraoperative hypotension remained the independent risk factors for pSAEs (P < .05), while the preoperative CH presented by decreasing its risk (P < .05).This study suggests that various intraoperative events including general anesthesia, hypotension were risk factors for the development of pSAEs. Preoperative CH, presenting with decreased incidence of intensive care unit (ICU) admission and pSAEs, may mimic hypoxic preconditioning in organic protection, for which further study is needed to uncover the underlying mechanisms.
authors.affiliation: Department of Anesthesiology Department of Orthopedics, Yan'an Hospital of Kunming City, Kunming Medical University, Kunming, China.
authors.forename: Furong
authors.initials: F
authors.lastname: Zhang
authors.forename: Ruqiang
authors.initials: R
authors.lastname: Zhang
authors.forename: Liang
authors.initials: L
authors.lastname: He
authors.forename: Jianwei
authors.initials: J
authors.lastname: Yin
authors.forename: Fang
authors.initials: F
authors.lastname: Wang
authors.forename: Junmin
authors.initials: J
authors.lastname: Li
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000531:Altitude; D000767:Anesthesia, Epidural / Q000009:adverse effects / Q000379:methods; D000768:Anesthesia, General / Q000009:adverse effects; D000775:Anesthesia, Spinal / Q000009:adverse effects / Q000379:methods; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000379:methods; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007022:Hypotension / Q000209:etiology; D000860:Hypoxia / Q000150:complications*; D007430:Intraoperative Care / Q000009:adverse effects* / Q000379:methods; D007431:Intraoperative Complications / Q000209:etiology*; D008297:Male; D015999:Multivariate Analysis; D009638:Norepinephrine / Q000008:administration & dosage; D010313:Partial Pressure; D011183:Postoperative Complications / Q000209:etiology*; D057234:Preoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D009638:Norepinephrine