Perioperative Blood Pressure Optimization to Improve Outcomes in Orthopedic Patients: A Clinical Review

Yu-fan Yang,1,2,* Xiaqing Ma,3,4,* Mudussar Abrar Ahmad,5 Paul Lee,6 Yibin Qin,3 Fu-hai Ji,1,2 Nazneen Sudhan,4 Ke Peng1,2,4 1Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China; 2Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, People’s Republic of China; 3Department of Anesthesiology, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, Jiangsu, People’s Republic of China; 4Department of Anesthesia and Intensive Care, Barking Havering and Redbridge University Hospitals NHS Trust, Romford, UK; 5Department of Orthopedics, Barking Havering and Redbridge University Hospitals NHS Trust, Romford, UK; 6College of Health and Science, University of Lincoln, Lincoln, UK*These authors contributed equally to this workCorrespondence: Ke Peng, Email [email protected] Nazneen Sudhan, Email [email protected]: Perioperative blood pressure fluctuations significantly contribute to postoperative complications in orthopedic surgery, particularly among high-risk patients. This clinical review synthesizes current evidence on individualized blood pressure management across the perioperative continuum, highlighting procedure-specific risks such as bone cement implantation syndrome, tourniquet-induced hemodynamic changes, and cerebral hypoperfusion in the beach-chair position. Special considerations for vulnerable populations, including frail elderly and anticoagulated patients, are discussed to balance bleeding and thrombotic risks. Maintaining mean arterial pressure within 10– 20% of baseline through tailored anesthesia, goal-directed fluid therapy, and continuous monitoring is associated with improved outcomes. A multidisciplinary, risk-stratified approach is recommended to reduce perioperative morbidity and improve postoperative outcomes. Future research should validate personalized blood pressure targets and explore the role of advanced hemodynamic monitoring in enhancing patient safety.Keywords: perioperative blood pressure, cardiovascular risk, orthopedic surgery, high-risk patients, hemodynamic monitoring, patient safety