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LBC04
October 13, 2014
3:00:00 PM - 4:30:00 PM
Room Room 244
Sonographic Assessment for the Incidence of and Risk Factors Associated With Intra-abdominal Fluid Extravasation Following Hip Arthroscopy
Natasha Desai, B.A., Jemiel Nejim, M.D., Stephen Haskins, M.D.
Hospital for Special Surgery, New York, New York , United States
Background: Symptomatic intra-abdominal fluid extravasation (sIAFE) after hip arthroscopy is a rare complication presenting with abdominal compartment syndrome (ACS). A retrospective study of over 25,000 hip arthroscopies concluded that the prevalence of sIAFE, requiring diuresis or surgical decompression, was 0.16% with risk factors including surgical procedure and high pump pressures (1). Information regarding IAFE remains rare and the incidence of asymptomatic IAFE (aIAFE), meaning new free fluid in the abdomen without ACS, has not been extensively studied. IAFE can be diagnosed by using abdominal ultrasonography (US). US of the abdomen and pelvis via the Focus Assessment with Sonography for Trauma (FAST) exam is a well-established means to detect free fluid with high sensitivity and specificity (2). In this study, we used US to determine the incidence of IAFE in patients undergoing hip arthroscopy. We hypothesized a higher incidence of IAFE than previously published and that patients with aIAFE would still have symptoms of abdominal irritation such as pain and nausea.

Methods: 44 patients undergoing ambulatory hip arthroscopy were prospectively enrolled. A FAST exam was performed following induction by a trained anesthesiologist to exclude the pre-operative presence of intra-abdominal fluid. Post-operatively the same anesthesiologist repeated the FAST exam and patients with new fluid in either the abdominal or pelvic compartment were diagnosed with IAFE (see Figure 1). Patients with new IAFE, but no signs of ACS, were categorized as aIAFE. Patients were followed in the PACU for 6 hours assessing pain, anti-emetic and opioid use, and length of stay (LOS).

Results: Of the 44 patients enrolled, no patients had sIAFE and 6 were found to have aIAFE (13.6%). Younger patients were more likely to have aIAFE (median age 21 vs. 32; p=0.009). Patients with aIAFE had higher pain scores in the PACU, particularly upon on arrival (p=0.038; see Figure 1). Patients with aIAFE also required more antiemetics (p=0.076). There were no differences in post-op opioid use (p=0.51) or LOS (p=0.95) between those with aIAFE. Surgical technique (p=0.15) and average pump pressures (p=0.14) did not correlate to IAFE.

Conclusions: Our incidence of aIAFE was 13.6%, which is 85-fold higher than previously reported for sIAFE, showing that aIAFE occurs quite commonly during hip arthroscopy. Unlike previous data, the surgical procedure and pump pressures did not increase risk for IAFE; only younger age correlated. Patients with aIAFE had higher pain scores and required more anti-emetics during their PACU stay, suggesting that even a small amount of new fluid in the abdomen worsens the post-operative experience. IAFE did not affect LOS or opioid use. Further studies with a larger sample size will be needed to identify potential surgical risk factors for aIAFE as well as ways to identify and improve management of patients with aIAFE.

References:

1) Kocher MS, Kelly BT et al. Intra-abdominal fluid extravasation during hip arthroscopy: a survey of the MAHORN group. Arthroscopy. 2012 Nov;28(11):1654-60.

2) Körner M, et al Current role of emergency US in patients with major trauma. Radiographics. 2008;28(1):225-42.
Figure 1

Copyright © 2014 American Society of Anesthesiologists