Journal Article

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

Rui, Chen, Rui, Yunfeng, Yin, Yueheng, Zhou, Shaoyang, Wang, Zhen

2026

Overview

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.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Acute kidney injury / Aged / Aged patients / Aged, 80 and over / Aging / Blood pressure / Clinical outcomes / Complications / Creatinine / Data collection / Delirium / Female / Fractures / Geriatrics / Hemoglobin / Hip / Hip fracture / Hip Fractures - mortality / Hip Fractures - surgery / Hip joint / Hospitals / Humans / Hypotension / Hypotension - complications / Hypotension - epidemiology / Intensive care / Intraoperative Complications - epidemiology / Intraoperative Complications - etiology / Intraoperative Complications - mortality / Intraoperative hypotension / Kidneys / Length of Stay - statistics & numerical data / Male / Medical diagnosis / Medical records / Medicine / Medicine & Public Health / Mortality / Normal distribution / Orthopedics / Patient outcomes / Patients / Pneumonia / Population / Postoperative / Postoperative Complications - epidemiology / Postoperative Complications - etiology / Postoperative Complications - mortality / Postoperative delirium / Postoperative period / Propensity Score / Retrospective Studies / Risk Factors / Surgery / Surgical Orthopedics / Tranexamic acid / Trauma / Treatment Outcome