A. P. Bain1, J. Odeh1, M. Reed1, S. Bishop1, J. Mansour1, S. Bartolome1 1University Of Texas Southwestern Medical Center, Dallas, TX, USA
Introduction:
Hypotension, hypoxia and hypothermia affect end organ and surgical site perfusion tissue oxygenation. The literature is mixed regarding the effect of these intraoperative physiologic events on post operative outcomes. Furthermore, identifying and abstracting these events can be laborious. The Operating Room Black Box™ (ORBB) is a novel data-analytic and safety monitoring platform that allows for “tagging” of intraoperative events such as hypotension, hypoxia, and hypothermia. We hypothesized that the presence of intraoperative tags would be associated with postoperative outcomes.
Methods:
This was a retrospective review of primarily robotic, elective surgical cases in a quaternary referral center. Intraoperative physiologic event tags were prospectively applied to all cases meeting criteria using the ORBB. Tags were applied for moderate and severe episodes of hypotension, hypothermia, and hypoxia. Association between presence of individual tags with outcomes of surgical site infection, patient safety indicator (PSI) flags, length of stay, readmission, return to OR, and mortality was performed using logistic regression or multiple linear regression where appropriate.
Results:
5831 cases were performed and monitored with the ORBB tag system between August 15 2020 – September 30 2022. Tags were applied in 949 cases (16%). The presence of hypotension and hypoxia tags were significantly associated with increased rate of surgical site infection (p<0.01) and increased PSI flags (p<0.02). Hypoxia tags were associated with increased rates of secondary operation, 3.5% vs 3.1% (p<0.01). However, these associations were no longer significant when adjusted for patient and case variables. Severe hypotension and hypothermia tags were associated with length of stay, 6.1 vs 5.4 days (p<0.03). Both hypotension and hypoxia were both significantly associated with increased rate of readmission, 8.3% vs 7.8% (p< 0.01). The presence of tags was not associated with an increase in mortality.
Conclusion:
While the presence of certain intraoperative physiologic event tags is independently associated with increased surgical site infection, PSI flags, and secondary operations, the significance disappears when adjusted for patient and case characteristics. Despite this, presence of tags remained associated with increased length of stay and readmission rates after adjustment. As real time OR data collection and monitoring becomes a reality, more work must be done to identify the intraoperative events in combination with patient factors that most affect patient outcome. Meaningful thresholds for intraoperative physiologic events must be defined as the first step in the goal of creating predictive algorithms that assist in optimal intraoperative and post operative care.