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GMS Interdiscip Plast Reconstr Surg DGPW. 2015 Jan 14;4:Doc03. doi: 10.3205/iprs000062. eCollection 2015.

Perioperative management of patients with severe pulmonary hypertension in major orthopedic surgery: experience-based recommendations.

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Medical Clinic and Polyclinic I, Department of Pneumology, Universitätsklinikum Leipzig AöR, Leipzig, Germany.
Clinic for Anesthesiology, Critical Care Medicine and Pain Therapy, St. Georg Hospital Leipzig, Germany.
Clinic for Orthopedic and Reconstructive Surgery, St. Georg Hospital Leipzig, Germany.
Clinic for Anesthesiology and Critical Care Medicine, Martin-Luther-University of Halle-Wittenberg, Halle/Saale, Germany.


in English, German


It is known that pulmonary hypertension is associated with worse outcome in both cardiac and non-cardiac surgery. The aims of our retrospective analysis were to evaluate the outcomes of our patients with pulmonary hypertension undergoing major orthopedic surgery and to give experience-based recommendations for the perioperative management.


From 92 patients with pulmonary hypertension undergoing different kinds of surgical procedures from 2011-2014 in a tertiary academic hospital we evaluated 16 patients with major orthopedic surgery for perioperative morbidity and mortality.


Regarding the in-hospital morbidity and mortality, one patient died postoperatively due to pulmonary infection and right heart failure (6.25%) and 6 patients suffered significant postoperative complications (37.5%; bleeding = 1, infection = 1, wound healing deficits = 3; dysrhythmia = 1).


Our data show that major orthopedic surgery is feasible with satisfactory outcome even in cases of severe pulmonary hypertension by an individualized, disease-adapted interdisciplinary treatment concept.


general anesthesia; intraoperative monitoring; local anesthesia; perioperative management; pulmonary hypertension

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