Leg compression for preventing hypotension after spinal anesthesia in elderly hip fracture patients

Hip fracture (HF) is a common geriatric trauma resulting in a substantial rate of mortality and morbidity. Previous studies have shown that the application of leg compression significantly reduced the incidence of perioperative hypotension (PeH) and hypotension-related complication in obstetric surgery. The objective of this study was to evaluate the effect of medical compression stocking for prevention of PeH in elderly patients undergoing HF surgery.

Sixty patients were randomized in 2 groups: compression stocking (CS) group and no compression stocking (NCS) group (n = 30 each). Compression stockings were worn on the uninjured leg after spinal anesthesia and then removed after 24 h postoperatively. Demographic and perioperative data were collected. Primary outcome was the incidence of PeH measuring as 3 methods: intraoperative hypotension (IoH), postoperative hypotension (PoH), and concomitant intraoperative and postoperative hypotension (CoIPH). The secondary outcomes were the incidence of using intraoperative vasopressor and in-hospital hypotension-related complications related to hip fracture.

Baseline characteristics such as age, gender, diagnosis and operation were not significant difference between groups (p > 0.05 all). Regards the PeH, CS group demonstrated a significantly lower incidence in CoIPH than NCS group (0 patients vs. 6 patients, p = 0.02), and also showed a non-significantly lower incidence of the PoH and hypotension-related complication (p = 0.13 and 0.10, respectively). However, the IoH, and the need of intraoperative vasopressor did not significantly differ between both groups (p > 0.05 all).

The application of medical compression stocking in elderly patients undergoing HF surgery demonstrated an ability to reduce the incidence of hypotension perioperatively and might prevent in-hospital hypotension-related complication.