Hypotension during hip fracture surgery and postoperative morbidity
| Autor: | Donal J. Buggy, Grace Crilly, Sebastian Vencken, Rachael Cusack, Gabriel Beecham |
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| Rok vydání: | 2019 |
| Předmět: |
Male
Mean arterial pressure Hip fracture surgery law.invention 03 medical and health sciences 0302 clinical medicine Postoperative Complications Randomized controlled trial law medicine Humans 030212 general & internal medicine Postoperative Period Aged Retrospective Studies Aged 80 and over Hip fracture business.industry Hip Fractures General Medicine Odds ratio medicine.disease Survival Rate Blood pressure Anesthesia Observational study Female Hypotension Morbidity Complication business 030217 neurology & neurosurgery |
| Zdroj: | Irish journal of medical science. 189(3) |
| ISSN: | 1863-4362 |
| Popis: | BackgroundHip fracture is a growing healthcare challenge, with 6–8% 30-day mortality and 20–30% of patients incurring major morbidity, including impaired mobilisation and ability to live independently. While observational studies have shown no benefit of general versus spinal anaesthesia on 30-day mortality, intraoperative hypotension during hip fracture surgery is associated with increased 30-day mortality regardless of anaesthetic technique. Although a recent trial on younger patients demonstrated reduced postoperative complications by maintaining intraoperative arterial blood pressure close to preoperative baseline, there are no data correlating intraoperative hypotension during hip fracture surgery with postoperative morbidity.ObjectiveWe evaluated the hypothesis that duration and severity of intraoperative hypotension during hip fracture surgery is associated with increased postoperative morbidity.MethodsA retrospective analysis was carried out onn = 52 patients undergoing hip fracture surgery between January and June 2017. Measurements of patients’ intraoperative systolic arterial pressure (SAP) and mean arterial pressure (MAP) during anaesthesia, logged electronically through an anaesthesia information management system, were reviewed. We calculated the total duration of time where SAP or MAP were below pre-defined thresholds for hypotension (MAP ResultsMean age (± SD) was 78 ± 13 years, 75% were female, 87% were ASA II or III and 60% underwent spinal anaesthesia. Mean Comprehensive Complication Index was 20.4 ± 19.2. Lowest absolute SAP and MAP values were 82 ± 18 mmHg and 55 ± 12 mmHg respectively. Cumulative time of SAP P = 0.003).ConclusionsIn this exploratory retrospective analysis, the cumulative time of hypotension during hip fracture surgery correlated with extensive postoperative morbidity when adjusting to other known predictors. Intraoperative cumulative time of hypotension may be a good candidate for larger prediction studies as a predictor of postoperative complications. A randomised controlled trial evaluating the effect of actively minimising intraoperative hypotension on postoperative morbidity in hip fracture patients seems warranted. |
| Databáze: | OpenAIRE |
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