Association of Preoperative Frailty and Post-Induction Hypotension in Elderly Patients Undergoing Major Non-Cardiac Surgery: A Prospective Observational Cohort Study

Jiawen Yu, Lu Che, Ruoxi Wang, Quexuan Cui, Li Xu, Yuguang Huang Department of Anesthesiology, Peking Union Medical College Hospital, Beijing, People’s Republic of ChinaCorrespondence: Li Xu, Peking Union Medical College Hospital, Beijing, People’s Republic of China, Email [email protected]: Post-induction hypotension (PIH) is one of the most common complications during general anesthesia, especially in elderly patients. Frailty, which describes age-related decrease of physiological capacity with increased susceptibility to stress, may be associated with PIH, when stress is brought by anesthetics. This study aimed to explore the association between preoperative frailty and PIH as well as postoperative complications.Patients and Methods: This study was a prospective observational cohort study. Elderly patients scheduled for elective non-cardiac surgery under general anesthesia were recruited from December 2019 to April 2022 in Peking Union Medical College Hospital. Preoperative frailty was assessed by FRAIL scale. The primary outcome was post-induction hypotension. Secondary outcome included postoperative complications, functional recovery, length of stay and hospital cost.Results: A total of 147 patients were included in the final analysis, of which 25 (17.0%) were considered frail. Frailty patients were generally older and suffered more from anemia, hypoalbuminemia, weakness, and orthostatic hypotension. The incidence of PIH was significantly higher in frail patients than non-frail elderly (80.0% vs 37.7%). Multivariable analysis revealed that frailty was associated with higher risk of PIH (aRR 1.72, 95% CI 1.20– 2.47, P=0.003) after adjusting for baseline characteristics, surgical type and intraoperative medications. Comprehensive complication index within 30 days after surgery was significantly higher in frail patients.Conclusion: Frailty is associated with post-induction hypotension during general anesthesia in elderly patients undergoing non-cardiac surgery. Preoperative frailty assessment may help identify high-risk patients for better anesthesia plan.Keywords: frailty, post-induction hypotension, orthostatic hypotension, autonomic dysfunction