Utility of Compass 31 Questionnaire to Predict the Autonomic Dysfunction and Intraoperative Hemodynamic Fluctuations and Correlate it with CASS Score in Patients with Compressive Cervical Myelopathy

Background: To assess utility of COMPASS-31 questionnaire as screening tool for diagnosing autonomic dysfunction (AND) and correlate it with modified CASS score to predict the severity of AND, intraoperative hemodynamic fluctuations in patients undergoing surgery for compressive cervical myelopathy (CCM).

Materials and Methods: After obtaining IRB approval and informed consent, 42 ASA I-II patients, aged 18 to 70 years, who underwent decompression for CCM were recruited. In the preoperative period, COMPASS 31 questionnaire was given in the language they could comprehend, and the total score was calculated. They underwent autonomic function tests and modified CASS score was calculated. During intraoperative period, standard anesthesia protocol followed and hemodynamics were noted at regular intervals throughout the surgery. Ephedrine/phenylephrine boluses or noradrenaline infusion was given to maintain a target BP within 20% of baseline. Amount of vasopressor used was recorded.

Results: The mean age of the patients studied was 48.76 ± 10.69 years. Fifty percent of patients had Nurick’s grades 2 and 3, and the rest had Nurick’s grades 4 and 5. All patients had AND varying from mild (46%), moderate (12%) to severe (42.9%). The median COMPASS-31 score (IQR: 25–75%) was 19 (6–33). Receiver operating characteristic (ROC) analysis revealed COMPASS-31 had fair accuracy with area under the curve (AUC) = 0.738 (p = 0.009). Total COMPASS-31 score of 30 had sensitivity of 52.2% and specificity of 89.5% to detect moderate to severe AND. The median (IQR: 25–75%) Modified CASS score was 3 (2–5). Moderately positive correlation 0.383 (p = 0.05) found between CASS and COMPASS-31 score. Nurick’s grade showed positive correlation with CASS/COMPASS-31with correlation coefficient of 0.35 (p = 0.023), 0.48 (p = 0.001), respectively. In patients with severe AND had significant hemodynamic fluctuation compared with mild/moderate AND.

Conclusion: COMPASS-31score of more than 30 correlated with moderate to severe AND. Patients with severe AND develops significant hemodynamic fluctuations during surgery more so in prone.

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Artikel online veröffentlicht:
25. März 2020