Effect of Goal-Directed Intraoperative Blood Pressure Management on Postoperative Delirium in Older Patients…

Randomized trialAnesthesia and analgesia· Jul 2026

Effect of Goal-Directed Intraoperative Blood Pressure Management on Postoperative Delirium in Older Patients Undergoing Hip Fracture Surgery: A Randomized Controlled Trial.

Ziyu Huang, Yunqi Zhu, Jing Yuan … Yi Feng

Perioperative MedicineRandomized trialTreatmentQ1IF 2.6

Goal-directed blood pressure management did not significantly cut postoperative delirium after hip fracture surgery

Effect of Goal-Directed Intraoperative Blood Pressure Management on Postoperative Delirium in Older Patients Undergoing Hip Fracture Surgery: A Randomized Controlled Trial.

Ziyu Huang … Yi Feng

Anesthesia and analgesia · Jul 2026 · Q1 in Anesthesiology

Background

Postoperative delirium is a frequent and serious complication in older patients after surgery, particularly following hip fracture repair surgery, with an incidence of 10% to 55%.

Purpose

The goal-directed arterial blood pressure group maintained systolic blood pressure (SBP) >80% preoperative values with continuous infusion of norepinephrine, while the control group aimed to keep SBP ≥90 mm Hg using intermittent administration of phenylephrine or ephedrine.

Methods

In this single-center randomized controlled trial, 188 older patients (over 65 years) scheduled for elective hip fracture repair surgeries under spinal anesthesia were randomized to either goal-directed arterial blood pressure (arterial blood pressure) group or control group.

n = 188 older patients

Results

goal-directed pressure control trended toward less delirium, but not significantly

RR 0.73 (95% CI 0.48 to 1.13)

null 1

0.48

1.13

CI crosses the null - not significant

More results

Accumulative time spent under 80% preoperative systolic blood pressure (SBP) values was significantly shorter in goal-directed arterial blood pressure group than in control group (0 [0-8] vs 12 [0-38] minutes; P < 0.001).

There was no difference in the incidence of postoperative intensive care unit admittance or quality of life at 3 months follow-up.

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Conclusion

Goal-directed intraoperative blood pressure management did not significantly reduce postoperative delirium in older patients undergoing hip fracture repair surgery under spinal anesthesia.

Effect of Goal-Directed Intraoperative Blood Pressure Management on Postoperative Delirium in Older Patients Undergoing Hip Fracture Surgery: A Randomized Controlled Trial.

Effect of Goal-Directed Intraoperative Blood Pressure Management on Postoperative Delirium in Older Patients Undergoing Hip Fracture Surgery: A Randomized Controlled Trial.

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