Tight intra-operative blood pressure control versus standard care for patients undergoing hip fracture repair – Hip Fracture Intervention Study for Prevention of Hypotension (HIP-HOP) trial: study protocol for a randomised controlled trial

Abstract

BackgroundHypotension during anaesthesia for hip fracture surgery is common. Recent data suggest that there is an association between the lowest intra-operative blood pressure and mortality, even when adjusted for co-morbidities. This is consistent with data derived from the wider surgical population, where magnitude and duration of hypotension are associated with mortality and peri-operative complications. However, there are no trial to data to support more aggressive blood pressure control.Methods/designWe are conducting a three-centre, randomised, double-blinded pilot study in three hospitals in the United Kingdom. The sample size will be 75 patients (25 from each centre). Randomisation will be done using computer-generated concealed tables. Both participants and investigators will be blinded to group allocation. Participants will be aged >70 years, cognitively intact (Abbreviated Mental Test Score 7 or greater), able to give informed consent and admitted directly through the emergency department with a fractured neck of the femur requiring operative repair. Patients randomised to tight blood pressure control or avoidance of intra-operative hypotension will receive active treatment as required to maintain both of the following: systolic arterial blood pressure >80% of baseline pre-operative value and mean arterial pressure >75 mmHg throughout. All participants will receive standard hospital care, including spinal or general anaesthesia, at the discretion of the clinical team. The primary outcome is a composite of the presence or absence of defined cardiovascular, renal and delirium morbidity within 7 days of surgery (myocardial injury, stroke, acute kidney injury, delirium). Secondary endpoints will include the defined individual morbidities, mortality, early mobility and discharge to usual residence.DiscussionThis is a small-scale pilot study investigating the feasibility of a trial of tight intra-operative blood pressure control in a frail elderly patient group with known high morbidity and mortality. Positive findings will provide the basis for a larger-scale study.Trial registrationISRCTN Registry identifier: ISRCTN89812075. Registered on 30 August 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-2066-5) contains supplementary material, which is available to authorized users.

Acute hip fracture surgery anaesthetic technique and 30-day mortality in Sweden 2016 and 2017: A retrospective register study

“…This may be an effect due to combined spinal and epidural anaesthesia being chosen for more complex procedures; however, this is merely speculation. Tight haemodynamic control maintaining blood pressure and heart rate within minimal deviation from preoperative values have been suggested to have a major impact, and studies assessing its effect are being conducted 13 . Optimising haemodynamics by ultrasound monitoring may also facilitate the perioperative course 14 .…”

Unsupervised Data Mining and Effect of Fast Rehabilitation Nursing Intervention in Fracture Surgery

“…Feature selection is a key technology used in imaging evaluation. It maintains the recognition accuracy after removing irrelevant features on the basis of maintaining the original target features, and it can be applied to imaging evaluation after fracture [ 7 , 8 ]. According to the types of network data, feature selection algorithms can be divided into semisupervised feature selection (SSFS), supervised feature selection (SFS), and unsupervised feature selection (UFS).…”

Hypotension during hip fracture surgery and postoperative morbidity

“…A recent prospective randomised controlled trial in younger, but higher risk, patients found that patients randomised to receive maintenance of intraoperative arterial blood pressure close to baseline had significantly reduced postoperative major morbidity compared with those randomised to standard intraoperative arterial blood pressure management [13]. Another ongoing multi-centre pilot study aims to assess outcomes in older hip fracture patients (aged more than 70 years) by randomising then between tight intraoperative blood pressure control and standard care [34]. This cohort of frail patients who had sustained hip fractures were at a high risk of organ failure even before surgery, as illustrated by their high Charlson Comorbidity Index (mean 5.7, estimated 10-year survival 2-21%).…”