Incidence and risk factors of arterial line placement–related complications in elderly patients undergoing hip arthroplasty under general anesthesia: A single-center retrospective study

This single-centre retrospective study included patients aged ≥65 years who underwent elective total hip arthroplasty under general anaesthesia with intra-arterial catheterisation between January 2021 and December 2023. Perioperative complications related to arterial line placement were identified and categorised as intraoperative or postoperative. Baseline characteristics were compared between patients with and without complications, and multivariable logistic regression was performed to identify independent risk factors. A total of 134 patients were included; 31 (23.8%) experienced perioperative complications related to arterial catheterisation. Among them, 15 (48.4%) developed intraoperative complications—most commonly arterial haematoma (16.1%) and arterial spasm (12.9%)—while 16 (51.6%) experienced postoperative complications such as infection (16.1%) and persistent bleeding (12.9%). No significant differences in age, sex, ASA class, or organ function were found between intraoperative and postoperative complication groups. Compared to patients without complications, those with complications had higher rates of hypertension (80.6% vs. 34.1%, P = 0.002), diabetes (38.7% vs. 19.5%, P = 0.019), and cardiac disease (19.4% vs. 7.3%, P = 0.004). Logistic regression confirmed diabetes (OR 2.06, 95% CI 1.12–3.75; P = 0.022) and cardiac disease (OR 3.20, 95% CI 1.14–9.02; P = 0.024) as independent predictors. BMI was not significant (OR 1.17, 95% CI 0.99–1.39; P = 0.087). Perioperative complications related to arterial catheterisation are relatively frequent among elderly patients undergoing hip arthroplasty. Diabetes and cardiac disease are independent risk factors, underscoring the importance of comprehensive preoperative assessment and risk stratification in this vulnerable population.