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Prolonged vasopressor support during hip-fracture surgery is a risk factor for enhanced mortality

Journal article
Authors J. Kristiansson
Fredrik Olsen
E. Hagberg
Robert Dutkiewicz
Bengt Nellgård
Published in Acta Anaesthesiologica Scandinavica
Volume 63
Issue 1
Pages 46-54
ISSN 0001-5172
Publication year 2019
Published at Institute of Clinical Sciences, Department of Anesthesiology and Intensive care
Pages 46-54
Language en
Links dx.doi.org/10.1111/aas.13215
Keywords intraoperative hypotension, noncardiac surgery, myocardial injury, blood-pressure, anesthesia, norepinephrine, association, definition, inotropes, outcomes
Subject categories Anaesthetics

Abstract

Background Hip fracture is a common injury in the elderly population and is associated with high morbidity and mortality. Intraoperative hypotension is commonly noted, and is often treated with vasopressors (VP), however, to what extent is unknown. We set out to examine retrospectively how many hip fracture-patients received VP perioperatively and further to investigate if VP treatment is connected to increased mortality. Method Data on VP treatment were captured from medical and anaesthesia journals, and if so, data were investigated to find potential confounders. Patients were divided into (a) no VP, (b) VP by injection, (c) VP by infusion <3 hours, and (d) VP by infusion >= 3 hours to achieve stratification. Results Nine hundred and ninety-seven patients were included. About 80.4% received VP treatment. The 30-day mortality rates in subgroups were 3.6%, 5.4%, 6.4% and 19.1% respectively. The 90-day mortality rates were 6.7%, 10.3%, 11.6% and 30.3% respectively. Finally, the same patient groups had 365-day mortality rates of 12.8%, 20.0%, 23.3% and 44.9% respectively. We found a significant increase in mortality (30-90-365 days) in patients receiving VP infusion >= 3 hours, after adjusting for confounding factors. There was no increased mortality in patients treated by injection and by infusion Conclusion Vasopressor treatment is common during hip fracture surgery. Patients treated with VP infusion >= 3 hours have increased mortality, while patients treated with injections or infusion

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