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

Abstract

Purpose: 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. Methods: 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. Results: 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). Conclusion: 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.