Intraoperative hypotension in older adults with hip fracture: a comparative analysis of different definitions
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Karin Vleeshouwers1, Sara Salman2, Martijn Poeze3,4
1Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands.
Purpose:
Intraoperative hypotension (IOH) is associated with adverse outcomes, but its definition varies widely and most definitions are derived from younger or mixed-age populations. Older adults undergoing hip fracture surgery are particularly susceptible due to reduced physiological reserve. This study compared absolute, relative, and duration-based definitions of IOH and evaluated their associations with postoperative adverse outcomes.
Methods:
This retrospective single-center cohort study included all patients aged ≥ 65 years who underwent hip fracture surgery at Maastricht University Medical Centre+ between January 2021 and December 2022. IOH was defined using absolute thresholds (MAP < 65 mmHg, SBP < 100 mmHg), relative reductions (≥ 20%), post-induction decreases, and duration below thresholds. Outcomes were acute kidney injury (AKI, KDIGO criteria), and 30 day mortality. Multivariable logistic regression models were adjusted for age-adjusted Charlson Comorbidity Index, ASA classification, medication use, and nursing home residency.
Results:
A total of 473 patients were included (mean age 80.9 years, 69.8% female). Postoperative AKI occurred in 9.9% and 30 day mortality in 5.5%. Absolute and relative IOH thresholds were not significantly associated with outcomes. In contrast, longer IOH duration (SBP < 100 mmHg) was associated with 30 day mortality (OR 1.09 per minute, 95%CI 1.02-1.16). After adjustment, higher ASA classification remained associated with AKI, while IOH duration remained significantly associated with mortality.
Conclusions:
In older patients undergoing hip fracture surgery, the duration of IOH, rather than static thresholds, appeared more strongly associated with adverse outcomes, particularly 30 day mortality. These findings highlight the potential clinical relevance of hypotension duration and support further prospective research to establish geriatric-specific IOH definitions and optimal perioperative blood pressure management strategies.
