Association of intraoperative cerebral and muscular tissue oxygen saturation with postoperative complications and length of hospital stay after major spine surgery: an observational study

<span class="paragraphSection"><div class="boxTitle">Abstract</div><strong>Background.</strong> Compromised tissue oxygenation is one of the root causes of dysfunction of various organs and postoperative complications. Oxygenation of different tissue beds may follow different patterns of change during physiological derangement.<strong>Methods.</strong> Patients undergoing elective major posterior spine surgery participated in this prospective observational study. Cerebral tissue oxygen saturation (SctO₂) was monitored on the upper forehead and muscular tissue oxygen saturation (SmtO₂) on the lower leg. The associations of various oxygenation indices with postoperative composite complications and length of hospital stay (LOH) were investigated.<strong>Results.</strong> The number of composite complications per patient was 3  (2) while the LOH was 6 (3) days (n = 102). Multiple SmtO₂ indices (maximum, minimum, mean, median, and area under curve (AUC)) were associated with composite complications (univariate analysis, <span style="font-style:italic;">P</span> < 0.05). No SctO₂ indices were associated with complications. Multiple SmtO₂ indices (maximum, mean, median, and AUC) showed differences (<span style="font-style:italic;">P</span> < 0.05) between patients with composite complications ≤3 and >3, respectively. SmtO₂ standard deviation, AUC, and AUC weighted, and SctO₂ standard deviation, were associated with LOH (univariate analysis, <span style="font-style:italic;">P</span> < 0.05). Two SmtO₂ indices (AUC and AUC weighted), showed differences (<span style="font-style:italic;">P</span> < 0.05) between the patients with an LOH ≤6 and >6 days, respectively. SmtO₂, but not SctO₂, indices improved the adjusted R² for composite complications (+54.0%, <span style="font-style:italic;">P</span> = 0.0001) and LOH (+19.0%, <span style="font-style:italic;">P</span> = 0.02) based on multiple linear models.<strong>Conclusions.</strong> Muscular tissue oxygenation has a stronger association with postoperative complications and length of hospital stay than cerebral tissue oxygenation after major spine surgery.</span>

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