P88. Impact of advanced hemodynamic monitoring on postoperative complications in multilevel posterior thoracolumbar fusions

BACKGROUND CONTEXT: Intra-Operative Hypotension (IOH) is a widely accepted factor in triggering neuro-monitoring alerts during spinal deformity correction. Its impact on postop complications is less well studied. The Hypotension Prediction Index (HPI) uses AI to predict hypotension and its possible causes, helping the anesthesia team make timely decisions to administer vasopressors, inotropes or fluids. PURPOSE: This study determines if HPI software decreases episodes of IOH resulting in a decrease in postop complications. STUDY DESIGN/SETTING: Prospective observational cohort. PATIENT SAMPLE: Adult patients undergoing elective, multi-level posterior thoracolumbar fusion in a multisurgeon single tertiary spine institution. OUTCOME MEASURES: Incidence of Intraoperative Hypotenstion (MAP<65mmHg), Postoperative complications METHODS: Adult patients undergoing elective, multi-level posterior thoracolumbar fusion, with BP monitoring using an a-line using HPI software were identified. A similar set of patients in whom the HPI software was not used were also identified. Demographic and surgical data, minutes of IOH and hypertension, volume of IVF, colloids, blood products and vasopressors administered intraop; urine output, volume of IVF, colloids and blood products administered 4 hours postop; number and type of postop complications were collected. RESULTS: The HPI and Non-HPI groups were similar in sex, age, BMI, ASA grade, number of surgical levels, estimated blood loss and operative time. A longer duration of IOH was seen in the Non-HPI group (13.3mins) compared to the HPI group (8.1mins, p=0.032). Longer duration of hypertension in the Non-HPI group (1.4mins) was also seen compared to the HPI group (0.5mins, p=0.029). Except for colloids intra-op, the volume of IVF and blood products administered intraop and 4 hours postop were similar. Urine output 4 hours postop was greater in the HPI group (819.1mL) compared to the Non-HPI group (619.8mL, p=0.022). There was a greater number of patients in the Non-HPI group who had a surgical site infection requiring return to the operating room (13% vs 2%, p=0.027), postop nausea and vomiting requiring medication (14% vs 0, p=0.004) and postop cognitive dysfunction (19% vs 6%, p=0.049). CONCLUSIONS: The use of HPI to predict IOH before its actual occurrence allows the anesthesia team to proactively prevent it. Using advanced hemodynamic monitoring may also decrease intraop hypertensive events. This is associated with a shorter duration of IOH, lower prevalence of postop complications and decreased length of stay. FDA Device/Drug Status: This abstract does not discuss or include any applicable devices or drugs.