The Risk Factors for Spinal Anesthesia-induced Hypotension in Patients Undergoing Hip Fracture Surgery among the Elderly: A Retrospective Cohort Study

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Raviwan Akarapatima

Abstract

Introduction: Hip fractures are increasing as the population ages, this is becoming a major public health problem, increasing the burden of all countries. Hip fracture surgery can be undertaken with spinal anesthesia; however, hypotension is the most common side effect of this technique. Spinal anesthesia-induced hypotension, even when treated, can lead to deterioration of the organs and systemic diseases. Objective: We aimed to examine the modifiable risk factors of pre-operative hypotension among elderly patients, who underwent hip fracture surgery utilizing spinal anesthesia. Materials and Methods: A retrospective cohort study was conducted in a university hospital, Thailand. Hip fracture patients who underwent hip fracture surgery under spinal anesthesia between; January 2014 and June 2019, were enrolled in this study. We collected patient characteristic, premedication, anesthetic factors and surgical factors from anesthetic and medical records of the hospital information system, and statistical analysis was performed using R program. Results: From the 186 patients, the incidence of spinal anesthesia-induced hypotension was 46.8%. The dependent risk factors with increased risk of hypotension after spinal anesthesia were; increasing age, decreasing of baseline systolic blood pressure, American Society of Anesthesiologists (ASA) classification 3, sensory analgesia; equal to or higher than T5 (adjusted odd ratio; adj. OR=7.16), and those who received antihypertensive drugs more than 1 type as premedication (adj. OR= 6.91). Conclusion: The number of antihypertensive drugs for premedication, and sensory analgesia were modifiable risk factors of hypotension after spinal anesthesia in hip fracture surgery.

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