Factors Associated with Hypotension in Patients Aged ≥ 80 Years Old with Hip Fracture Surgery Under Spinal Anesthesia at Hatyai Hospital
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Introduction: Hip fractures are a common reason for surgery in older individuals. Spinal anesthesia is widely used for these procedures, but it is frequently associated with intraoperative hypotension, which may result in severe complications. This study aims to identify perioperative factors that increase the risk of hypotension following spinal anesthesia in extremely elderly patients undergoing hip fracture surgery. Methods: This prognostic factor research with retrospective observational cohort design included patients aged 80 yr and older who underwent hip fracture surgery under spinal anesthesia at Hatyai hospital between October 2016 and September 2023. Baseline characteristics, as well as surgical and anesthetic factors, were collected from medical records. Pre-spinal risk factors were analyzed using univariable and multivariable logistic regression to determine their association with spinal hypotension. Results: Among the 319 patients analyzed, 201 (63%) developed hypotension after spinal anesthesia. Risk factors identified included age over 85 yr, a BMI of 25 kg/m² or higher, the use of renin-angiotensin-aldosterone system antagonists on the day of surgery, the presence of an intertrochanteric fracture, and a surgery delay of more than 14 days after injury. Conclusion: In extremely elderly patients scheduled for hip fracture surgery under spinal anesthesia, careful consideration should be given to the selection of preoperative antihypertensive medications to mitigate the risk of hypotension. Moreover, minimizing surgical delays is critical to optimizing patient outcomes.
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