• Johan Kristiansson, Fredrik Olsen, Eva Hagberg, Robert Dutkiewicz, and Bengt Nellgård.
• Department of Anaesthesiology and Intensive Care, Sahlgrenska University Hospital, Mölndal, Sweden.
• Acta Anaesthesiol Scand. 2019 Jan 1; 63 (1): 46-54.

BackgroundHip 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.MethodData 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.ResultsNine 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 <3 hours after adjustment for confounding factors vs untreated patients.ConclusionVasopressor treatment is common during hip fracture surgery. Patients treated with VP infusion ≥3 hours have increased mortality, while patients treated with injections or infusion <3 hours have not. We suggest that the prolonged use of VP treatment is linked to increased mortality.© 2018 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

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