Pre-emptively holding ACE-Is and CCBs post-op reduced severe hypotension days from 0.62 to 0.28 and increased appropriate holding from 40% to 88%.
Does pre-emptively holding ACE-Is and CCBs for 48 hours post-operatively reduce the incidence and duration of hypotension in elderly patients undergoing neck of femur fracture surgery?
Pre-emptively withholding ACE-Is and CCBs for 48 hours post-operatively in elderly patients undergoing neck of femur fracture surgery significantly reduces the incidence and duration of severe hypotension.
Absolute Event Rate: 0% vs 0%
Abstract Introduction Elderly patients undergoing surgery for neck of femur (NOF) fractures are at high risk of post-operative hypotension due to reduced physiological reserve. Hypotension in this context is associated with an increased risk of cardiovascular events and impaired recovery. Therefore, senior clinicians often pre-emptively hold angiotensin-converting enzyme inhibitors (ACE-Is) and calcium channel blockers (CCBs) for 48 hours post-operatively, but this practice is inconsistently followed by resident doctors. We audited the prevalence and impact of this practice and introduced an intervention to improve consistency. Methods A two-cycle audit was conducted on an orthogeriatric ward. Inclusion criteria were patients aged 65 requiring surgery for NOF fractures. Data collected included antihypertensive use on admission, whether antihypertensives were held post-operatively, systolic blood pressure on post-operative days (POD) 1–3, episodes of moderate (90–100 mmHg) and severe (90 mmHg) systolic hypotension, and potential confounders (haemoglobin drop, fluid resuscitation, age). Ethical approval was waived. After the first cycle, an intervention was introduced: (1) an induction teaching session for resident doctors and (2) a revised post-op proforma prompting holding of ACE-Is and CCBs. Results Twenty-four patients were included pre-intervention, and 25 post-intervention. 75% of patients were taking at least one antihypertensive on admission. Already in the first cycle, patients in whom antihypertensives were held pre-emptively had significantly fewer days of severe hypotension in POD 1–3 (0.36 vs. 0.64 days, p = 0.03). Prior to the intervention, antihypertensives were appropriately held in 40% of cases. Post-intervention, this rose to 88% (p = 0.04). The average number of days with severe hypotension decreased from 0.62 to 0.28 (p = 0.03), and hypotension incidence fell from 35% to 28% (p = 0.01). Conclusion Pre-emptively withholding ACE-Is and CCBs post-operatively for 48 hours in elderly patients reduces the incidence and duration of hypotension. Teaching and documentation prompts can embed this practice into routine care and improve post-operative outcomes.
Turna et al. (Sun,) reported a other. Pre-emptively holding ACE-Is and CCBs post-op reduced severe hypotension days from 0.62 to 0.28 and increased appropriate holding from 40% to 88%.