Clinical Outcomes Associated with Diagnosis of Orthostatic Hypotension Among Oncology Patients in the Inpatient Rehabilitation Setting

Background and/or Objectives: Orthostatic hypotension (OH) confers increased risk of morbidity and mortality for hospitalized patients, and has been identified in particular as a risk for patients with cancer requiring inpatient rehabilitation. In this study, we examined the prevalence of OH among patients with cancer undergoing IPR, identified risk factors for OH in this population, and evaluated associations between a diagnosis of OH and rehabilitation outcomes.

Design: Retrospective study of adult patients admitted to a comprehensive cancer center and undergoing inpatient rehabilitation (IPR).

Setting : Large academic medical center.

Participants : We screened 490 consecutive patients who were admitted to this IPR between February 2023 and September 2024 for in-hospital measurement of orthostatic vitals. 199 patients had at least 1 complete measurement of orthostatic vitals, and 291 did not have orthostatic vital signs measured.

Interventions: Patients diagnosed with OH received interventions including compression stockings, abdominal binder, IV hydration, midodrine, fludrocortisone, and/or discontinuation of antihypertensive medications.

Main Outcome Measures: Hospital and IPR LOS; FIM scores including sit-to-stand transfer and gait. Differences between patients with and without documented OH were evaluated using a t-test, rank-sum test, and chi-squared analysis.

Results: Among 490 patients, 199 had their orthostatic blood pressure measurement completed upon admission to IPR. Among these 199 patients, 92 (45.7%) were found to have OH. Use of alpha-2 adrenergic agonist was associated with a diagnosis of OH (p < 0.001). LOS for overall hospitalization and IPR were similar between patients with and without OH (p=0.13 and 0.056, respectively). Median hospital LOS and IPR LOS for patients with OH were longer than those without OH, however these trends did not meet statistical significance.

Conclusions: Nearly one-half of patients with cancer undergoing IPR were diagnosed with OH, but the diagnosis was not associated with longer LOS or lower FIM scores. Routine assessment of OH can help identify high-risk IPR patients and tailor interventions to reduce risk.