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Background and Aims The beach-chair position (BCP) is commonly used for shoulder surgery but is known to increase hypotension incidence. Older age and interscalene brachial plexus block (ISB) have also been identified as risk factors for hypotension during BCP. As altered blood pressure control mechanisms and autonomic dysfunction, which cause hypotension, are more likely to occur in frail older patients, we investigated the association between preoperative frailty and hypotension during BCP in older patients.
Methods Patients aged ≥ 65 years who underwent elective total shoulder arthroplasty in BCP under general anesthesia with preoperative ISB were included. The frailty of participants was assessed before surgery using the Reported Edmonton Frail Scale. Quadriceps depth was measured by ultrasound preoperatively, and values < 2.3cm were considered significant. Hypotension was defined as a mean blood pressure < 65mmHg or a decrease of ≥ 20% from baseline.
Results Data were analyzed from 46 patients (mean age: 72.8 yrs). The incidence of hypotension during BCP was 71.7% (non-frail/prefrail/frail; 70.3%, 80% and 100%). A decreased quadriceps depth < 2.3cm was an independent risk factor for hypotension during BCP (odds ratio, 8.49, 95% confidence interval [CI], 1.38 – 51.90). The predictive power of hypotension during BCP was higher when both frailty and quadriceps depth were considered together, compared to considering frailty alone (AUC [95% CI], 0.766 [0.60-0.89] vs 0.51 [0.35-068], p=0.01).
Conclusions A reduced quadriceps depth is associated with hypotension during BCP. Assessing both frailty and quadriceps depth may enhance the screening tool for identifying older patients at risk of developing hypotension during BCP.
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