Individualized blood pressure management and postoperative organ dysfunction in older hip fracture patients: a study protocol for a single-center, randomized, controlled trial.

BACKGROUND: Postoperative organ dysfunction is a leading cause of death and disability following hip fracture surgery in older patients. Intraoperative hypotension is a major modifiable risk factor for this complication, yet the optimal management strategy to prevent it remains controversial. We hypothesize that an individualized blood pressure management strategy is superior to standard management in reducing postoperative organ dysfunction. METHODS: This single-center, randomized, controlled trial will enroll 180 patients aged 65-85 years with hip fractures under general anesthesia. Eligible patients will be randomly allocated in a 1:1 ratio to the individualized management group (targeting systolic blood pressure within ± 10% of baseline) or the standard management group (reactive management, where intervention is initiated only if systolic blood pressure < 90 mmHg or decrease of > 30% from baseline). A universal mean arterial pressure target of ≥ 65 mmHg will be maintained for all patients. The allocated hemodynamic management strategy will be maintained throughout surgery and during the post-anesthesia care unit stay. The primary outcome is a composite of dysfunction in at least one organ system (respiratory, cardiovascular, renal, and neurological) within 7 days after surgery. Secondary outcomes include the components of the primary outcome, intraoperative variables (including hemodynamic management data, fluid balance, blood loss, and serum lactate levels), intensive care unit and hospital stay, and all-cause mortality within 30 days after surgery. DISCUSSION: This randomized controlled trial aims to determine whether individualized blood pressure management reduces postoperative organ dysfunction more effectively than standard management in older hip fracture surgery patients. If proven effective, this proactive approach may represent a significant advance in clinical practice, moving from reactive hypotension correction to preventive stabilization, potentially reducing major complications, shortening hospital stays, and improving functional recovery. The results will provide important evidence to guide hemodynamic management during general anesthesia in this vulnerable population, contributing to standardized, evidence-based protocols for enhancing perioperative outcomes. TRIAL REGISTRATION: Trial registration: Chinese Clinical Trial Registry, ChiCTR2400093838. Registered on 12 December 2024. This manuscript presents the study protocol; participant recruitment is ongoing and results will be reported upon trial completion.