Incidence, Risk-factors, and Outcomes of Intraoperative Hypotension Following Spinal Anesthesia in Hip Fracture Surgery: A Retrospective Study from Thailand

Abstract

Objective: Hip fractures are a major health problem in older individuals. Surgical repair is the recommended treatment. Intraoperative hypotension (IOH) due to spinal anesthesia is common and may be associated with unfavorable outcomes. This study aimed to identify the incidence, risk factors, and outcomes of IOH in patients with hip fracture under spinal anesthesia. Materials and Methods: Retrospective data from a Thai hospital (January 2018-December 2020) were reviewed. Patients over 50 who underwent hip surgery were included, excluding those receiving general anesthesia, with high-energy/pathological fractures, or multiple traumas. Patients were categorized into no-IOH and IOH groups, with outcome measures compared. Results: In total, 264 patients were included for analysis. The mean age was 80.9 ± 8.3 years, with 77.3% females. The incidence of IOH was 37.9% [95% CI: 30.8%, 46.1%] and an independent risk factor was age > 65 years (OR [95% CI]: 6.23 [1.13, 34.47]. The two protective factors for IOH were higher preoperative mean arterial pressure (OR [95% CI]: 0.96 [0.93, 0.99]) and time from fracture to surgery > 24 hours (OR [95% CI]: 0.43 [0.21, 0.89]). Postoperative blood transfusions were administered more frequently (53.7%) in the IOH group than in the no-IOH group (37.9%, p = 0.014). Conclusion: The incidence of intraoperative hypotension in hip fracture surgery was 38%. Aging is the only identified risk factor. IOH was related to a higher frequency of blood transfusion, but no other postoperative complications or mortality rates.