Does orthopedic surgery typically manage outpatient hypertension after surgery?

Postoperative Hypertension Management After Orthopedic Surgery

Orthopedic surgeons should not typically manage outpatient hypertension after surgery; this responsibility should remain with primary care providers or referring physicians who manage the patient's chronic medical conditions. 1, 2

Roles and Responsibilities in Postoperative Hypertension Management

Primary Responsibility

• Postoperative hypertension management falls outside the typical scope of orthopedic surgical practice
• The Association of Anaesthetists of Great Britain and Ireland and the British Hypertension Society guidelines clearly indicate that chronic hypertension management belongs in primary care 1
• When elevated blood pressure is detected postoperatively, orthopedic surgeons should refer patients back to their primary care providers for ongoing management 1

Appropriate Workflow

1. Immediate postoperative period (PACU/recovery): Anesthesia team manages acute blood pressure issues
2. Inpatient setting: Hospital medicine team or consulting internal medicine manages blood pressure
3. Outpatient follow-up: Primary care physician resumes chronic hypertension management

Blood Pressure Thresholds for Action

• Urgent referral needed: SBP ≥180 mmHg or DBP ≥110 mmHg 1
• Non-urgent referral recommended: SBP 160-179 mmHg or DBP 100-109 mmHg 1
• Notification to PCP without delaying care: SBP 140-159 mmHg or DBP 90-99 mmHg 1

Specific Considerations for Orthopedic Patients

• Hypertension is common in orthopedic patients, with studies showing prevalence as high as 53% 3
• Uncontrolled hypertension can increase risk of:
  • Surgical site bleeding
  • Wound healing complications
  • Cardiovascular events
  • Increased length of stay

When Orthopedic Surgeons Should Intervene

While chronic management belongs to primary care, orthopedic surgeons should:

1. Document blood pressure abnormalities in postoperative notes
2. Communicate with primary care about significant blood pressure elevations
3. Ensure proper handoff of hypertension management responsibilities
4. Recognize emergent situations requiring immediate intervention (e.g., hypertensive crisis with end-organ damage)

Common Pitfalls to Avoid

• Failure to communicate: Not notifying primary care about significant blood pressure elevations
• Inappropriate medication adjustments: Making changes to chronic antihypertensive regimens without coordination with primary care
• Overlooking secondary causes: Not considering pain, anxiety, or urinary retention as causes of transient hypertension 2
• Delayed referrals: Not referring patients with severe hypertension (≥180/110 mmHg) for prompt evaluation 1

Special Considerations

• For patients undergoing major orthopedic surgery with severe hypertension, an interdisciplinary approach involving internal medicine or cardiology consultation is recommended 4
• Patients with labile blood pressure during surgery may require more intensive monitoring in the immediate postoperative period 1
• Orthopedic surgeons should ensure patients resume their home antihypertensive medications as soon as clinically appropriate 2

By following these guidelines, orthopedic surgeons can ensure appropriate care transitions while focusing on their primary responsibility of managing the surgical aspects of patient care.