Risk Factors for Intraoperative Hypotension in Elderly Patients Undergoing Fast Track Hip Fracture Surgery under Spinal Anesthesia: A Retrospective Observational Study

Samita Pirotesak; Waroonwan Neti; Phuengjai Weerapong; Bharadee  Teeravidja; Pawinee  Pangthipampai; Busara Sirivanasandha

doi:10.33192/smj.v76i7.269205

Authors

Samita Pirotesak Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Waroonwan Neti Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Phuengjai Weerapong Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Bharadee Teeravidja Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Pawinee Pangthipampai Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Busara Sirivanasandha Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand

DOI:

https://doi.org/10.33192/smj.v76i7.269205

Keywords:

Fast-track hip fracture, intraoperative, hypotension, risk factors, spinal anesthesia

Abstract

Objective: Fast-track hip fracture surgery is urgent. Time-limited preoperative optimization increase the risk of perioperative cardiovascular issues, affecting postoperative outcomes. This study aimed to identify risk factors for intraoperative hypotension in elderly patients undergoing fast-track hip fracture surgery with spinal anesthesia.

Materials and Methods: This retrospective observational analysis was conducted at a university-based hospital. Medical records from 2018 to 2022 were examined to compare variables associated with intraoperative hypotension. Multivariate logistic regression analysis was used to determine the risk variables for intraoperative hypotension.

Results: The incidence of intraoperative hypotension was 50.1%. Significant factors associated with intraoperative hypotension included a history of previous stroke (adjusted odds ratio [OR]: 2.41; 95% confidence interval [CI]: 1.38–4.21, P = 0.002), a preoperative baseline SBP below 100 mmHg (adjusted OR: 2.34; 95% CI: 1.34–4.08, P = 0.003), a preoperative urine output less than 0.5 ml/kg/h (adjusted OR: 2.74; 95% CI: 1.07–6.96, P = 0.034), undergoing an intramedullary nail procedure (adjusted OR: 2.64; 95% CI: 1.85–3.77, P < 0.001). Conversely, protective factors included receiving preoperative blood transfusions (adjusted OR: 0.43; 95% CI: 0.24–0.77, P = 0.004) and receiving a spinal bupivacaine dose of 7.5 mg or above (adjusted OR: 0.59; 95% CI: 0.36–0.95, P = 0.033).

Conclusion: Modifiable factors include ensuring adequate preoperative intravascular volume to optimize urine output and blood pressure, and correcting anemia. Prioritizing these measures for at-risk patients can help prevent complicated hospital stays.

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