Intraoperative hypotension is associated with adverse postoperative clinical outcomes in elderly patients with hip fractures

BACKGROUND: With population aging, hip fractures in elderly patients are a major medical problem. The impact of intraoperative hypotension (IOH) on adverse postoperative outcomes such as complications and mortality remains controversial. This study aimed to clarify this relationship for clinical guidance. METHODS: A retrospective analysis was performed on patients over 65 years of age who had hip fracture surgery from July 2019 to Dec 2023. Patients were divided into IOH and No IOH groups. Propensity score matching (PSM) was used to reduce confounding factors. The primary outcome measures included postoperative complications (were grouped as one to two complications and three or more complications) and postoperative mortality. The secondary outcome measures included specific complications and length of hospital stay (LOS). RESULTS: After PSM, 546 patients were included. The IOH group had a higher proportion of patients with three or more postoperative complications (3.0% vs 0%). The total duration of IOH was an independent risk factor for both three or more postoperative complications and postoperative cardiovascular events. Postoperative delirium (POD) was associated with the total duration of IOH at a lower threshold (MAP ≤ 55 mmHg); mortality and acute kidney injury (AKI) incidence showed no significant differences between groups. CONCLUSION: Our results provide evidence of the associations between IOH and its detailed exposure metrics with adverse postoperative outcomes in elderly patients with hip fractures, and reveal that POD is associated with the total duration of IOH at a lower threshold (MAP ≤ 55 mmHg) in this population.