{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T13:51:44Z","timestamp":1781877104494,"version":"3.54.5"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T00:00:00Z","timestamp":1777680000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T00:00:00Z","timestamp":1781827200000},"content-version":"vor","delay-in-days":48,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100007129","name":"Natural Science Foundation of Shandong Province","doi-asserted-by":"publisher","award":["ZR2023MH207"],"award-info":[{"award-number":["ZR2023MH207"]}],"id":[{"id":"10.13039\/501100007129","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Horizontal Research Project Funds of Shandong University","award":["6010124217"],"award-info":[{"award-number":["6010124217"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Geriatr"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single-center, randomized, controlled trial will enroll 180 patients aged 65\u201385\u00a0years 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\u2009\u00b1\u200910% of baseline) or the standard management group (reactive management, where intervention is initiated only if systolic blood pressure\u2009&lt;\u200990\u00a0mmHg or decrease of\u2009&gt;\u200930% from baseline). A universal mean arterial pressure target of\u2009\u2265\u200965\u00a0mmHg 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\u00a0days 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\u00a0days after surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>Trial registration: Chinese Clinical Trial Registry, ChiCTR2400093838. Registered on 12 December 2024. This manuscript presents the study protocol;\u00a0participant recruitment is ongoing and results will be reported upon trial completion.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12877-026-07594-5","type":"journal-article","created":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T05:36:21Z","timestamp":1777700181000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Individualized blood pressure management and postoperative organ dysfunction in older hip fracture patients: a study protocol for a single-center, randomized, controlled trial"],"prefix":"10.1186","volume":"26","author":[{"given":"WeiRan","family":"Zhang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"NingNing","family":"Fang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"XiuYu","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lian","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"ShaoZhong","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,2]]},"reference":[{"issue":"6","key":"7594_CR1","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1038\/nrendo.2014.51","volume":"10","author":"JA Cauley","year":"2014","unstructured":"Cauley JA, Chalhoub D, Kassem AM, Fuleihan GH. Geographic and ethnic disparities in osteoporotic fractures. Nat Rev Endocrinol. 2014;10(6):338\u201351.","journal-title":"Nat Rev Endocrinol"},{"issue":"5","key":"7594_CR2","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1001\/jama.2009.50","volume":"301","author":"D Bliuc","year":"2009","unstructured":"Bliuc D, Nguyen ND, Milch VE, Nguyen TV, Eisman JA, Center JR. Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA. 2009;301(5):513\u201321.","journal-title":"JAMA"},{"issue":"2","key":"7594_CR3","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1001\/jamasurg.2019.4471","volume":"155","author":"BG Maxwell","year":"2020","unstructured":"Maxwell BG, Spitz W, Porter J. Association of increasing use of spinal anesthesia in hip fracture repair with treating an aging patient population. JAMA Surg. 2020;155(2):167\u20138.","journal-title":"JAMA Surg"},{"issue":"7","key":"7594_CR4","doi-asserted-by":"publisher","first-page":"952","DOI":"10.7326\/M22-0320","volume":"175","author":"MD Neuman","year":"2022","unstructured":"Neuman MD, Feng R, Ellenberg SS, Sieber F, Sessler DI, Magaziner J, et al. Pain, analgesic use, and patient satisfaction with spinal versus general anesthesia for hip fracture surgery: A randomized clinical trial. Ann Intern Med. 2022;175(7):952\u201360.","journal-title":"Ann Intern Med"},{"issue":"8","key":"7594_CR5","doi-asserted-by":"publisher","first-page":"428","DOI":"10.1136\/rapm-2023-104454","volume":"48","author":"ES Schwenk","year":"2023","unstructured":"Schwenk ES, McCartney CJ. General anesthesia is an acceptable choice for hip fracture surgery. Reg Anesth Pain Med. 2023;48(8):428\u20139.","journal-title":"Reg Anesth Pain Med"},{"issue":"2","key":"7594_CR6","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1007\/s10877-021-00653-9","volume":"36","author":"B Saugel","year":"2022","unstructured":"Saugel B, Bebert EJ, Briesenick L, Hoppe P, Greiwe G, Yang D, et al. Mechanisms contributing to hypotension after anesthetic induction with sufentanil, propofol, and rocuronium: a prospective observational study. J Clin Monit Comput. 2022;36(2):341\u20137.","journal-title":"J Clin Monit Comput"},{"issue":"5","key":"7594_CR7","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2024-095466","volume":"15","author":"T Li","year":"2025","unstructured":"Li T, Zang H, Che L, Cui Q, Xu L. Correlation between postprandial hypotension and post-induction hypotension in the elderly: a protocol for a prospective cohort study. BMJ Open. 2025;15(5):e095466.","journal-title":"BMJ Open"},{"key":"7594_CR8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinane.2023.111125","volume":"88","author":"W Duan","year":"2023","unstructured":"Duan W, Zhou CM, Yang JJ, Zhang Y, Li ZP, Ma DQ, et al. A long duration of intraoperative hypotension is associated with postoperative delirium occurrence following thoracic and orthopedic surgery in elderly. J Clin Anesth. 2023;88:111125.","journal-title":"J Clin Anesth"},{"issue":"3","key":"7594_CR9","doi-asserted-by":"publisher","first-page":"515","DOI":"10.1097\/ALN.0000000000000765","volume":"123","author":"LY Sun","year":"2015","unstructured":"Sun LY, Wijeysundera DN, Tait GA, Beattie WS. Association of intraoperative hypotension with acute kidney injury after elective noncardiac surgery. Anesthesiology. 2015;123(3):515\u201323.","journal-title":"Anesthesiology"},{"issue":"6","key":"7594_CR10","doi-asserted-by":"publisher","first-page":"2079","DOI":"10.1097\/CCM.0b013e3181a00a43","volume":"37","author":"N Brienza","year":"2009","unstructured":"Brienza N, Giglio MT, Marucci M, Fiore T. Does perioperative hemodynamic optimization protect renal function in surgical patients? A meta-analytic study. Crit Care Med. 2009;37(6):2079\u201390.","journal-title":"Crit Care Med"},{"issue":"3","key":"7594_CR11","doi-asserted-by":"publisher","first-page":"507","DOI":"10.1097\/ALN.0b013e3182a10e26","volume":"119","author":"M Walsh","year":"2013","unstructured":"Walsh M, Devereaux PJ, Garg AX, Kurz A, Turan A, Rodseth RN, et al. Relationship between intraoperative mean arterial pressure and clinical outcomes after noncardiac surgery: toward an empirical definition of hypotension. Anesthesiology. 2013;119(3):507\u201315.","journal-title":"Anesthesiology"},{"issue":"2","key":"7594_CR12","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1111\/anae.15535","volume":"77","author":"AJ Wickham","year":"2022","unstructured":"Wickham AJ, Highton DT, Clark S, Fallaha D, Wong DJN, Martin DS. Treatment threshold for intra-operative hypotension in clinical practice-a prospective cohort study in older patients in the UK. Anaesthesia. 2022;77(2):153\u201363.","journal-title":"Anaesthesia"},{"issue":"5","key":"7594_CR13","doi-asserted-by":"publisher","first-page":"506","DOI":"10.1111\/anae.13415","volume":"71","author":"SM White","year":"2016","unstructured":"White SM, Moppett IK, Griffiths R, Johansen A, Wakeman R, Boulton C, et al. Secondary analysis of outcomes after 11,085 hip fracture operations from the prospective UK Anaesthesia Sprint Audit of Practice (ASAP-2). Anaesthesia. 2016;71(5):506\u201314.","journal-title":"Anaesthesia"},{"issue":"2","key":"7594_CR14","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1111\/anae.15291","volume":"76","author":"R Griffiths","year":"2021","unstructured":"Griffiths R, Babu S, Dixon P, Freeman N, Hurford D, Kelleher E, et al. Guideline for the management of hip fractures 2020: guideline by the Association of Anaesthetists. Anaesthesia. 2021;76(2):225\u201337.","journal-title":"Anaesthesia"},{"issue":"14","key":"7594_CR15","doi-asserted-by":"publisher","first-page":"1346","DOI":"10.1001\/jama.2017.14172","volume":"318","author":"E Futier","year":"2017","unstructured":"Futier E, Lefrant JY, Guinot PG, Godet T, Lorne E, Cuvillon P, et al. Effect of individualized vs standard blood pressure management strategies on postoperative organ dysfunction among high-risk patients undergoing major surgery: a randomized clinical trial. JAMA. 2017;318(14):1346\u201357.","journal-title":"JAMA"},{"issue":"4","key":"7594_CR16","doi-asserted-by":"publisher","first-page":"2894","DOI":"10.1097\/JS9.0000000000002289","volume":"111","author":"Z Pang","year":"2025","unstructured":"Pang Z, Liang S, Zhou N, Zhu X, Guo Q, Sessler DI, et al. Individualized blood pressure regulation and acute kidney injury in older patients having major abdominal surgery: a pilot randomized trial. Int J Surg. 2025;111(4):2894\u2013902.","journal-title":"Int J Surg"},{"key":"7594_CR17","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2025.17235","author":"B Saugel","year":"2025","unstructured":"Saugel B, Meidert AS, Brunkhorst FM, Bischoff R, Esser J, Mattis M, et al. Individualized perioperative blood pressure management in patients undergoing major abdominal surgery: the IMPROVE-multi randomized clinical trial. JAMA. 2025. https:\/\/doi.org\/10.1001\/jama.2025.17235.","journal-title":"JAMA"},{"issue":"6","key":"7594_CR18","doi-asserted-by":"publisher","first-page":"1262","DOI":"10.1213\/ANE.0000000000006208","volume":"135","author":"M Simonin","year":"2022","unstructured":"Simonin M, Delsuc C, Meuret P, Caruso L, Deleat-Besson R, Lamblin A, et al. Hypobaric unilateral spinal anesthesia versus general anesthesia for hip fracture surgery in the elderly: a randomized controlled trial. Anesth Analg. 2022;135(6):1262\u201370.","journal-title":"Anesth Analg"},{"issue":"22","key":"7594_CR19","doi-asserted-by":"publisher","first-page":"2025","DOI":"10.1056\/NEJMoa2113514","volume":"385","author":"MD Neuman","year":"2021","unstructured":"Neuman MD, Feng R, Carson JL, Gaskins LJ, Dillane D, Sessler DI, et al. Spinal anesthesia or general anesthesia for hip surgery in older adults. N Engl J Med. 2021;385(22):2025\u201335.","journal-title":"N Engl J Med"},{"issue":"1","key":"7594_CR20","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1001\/jama.2021.22647","volume":"327","author":"T Li","year":"2022","unstructured":"Li T, Li J, Yuan L, Wu J, Jiang C, Daniels J, et al. Effect of Regional vs General Anesthesia on Incidence of Postoperative Delirium in Older Patients Undergoing Hip Fracture Surgery: The RAGA Randomized Trial. JAMA. 2022;327(1):50\u20138.","journal-title":"JAMA"},{"issue":"7","key":"7594_CR21","doi-asserted-by":"publisher","first-page":"863","DOI":"10.1111\/anae.14225","volume":"73","author":"SM White","year":"2018","unstructured":"White SM, Altermatt F, Barry J, Ben-David B, Coburn M, Coluzzi F, et al. International Fragility Fracture Network Delphi consensus statement on the principles of anaesthesia for patients with hip fracture. Anaesthesia. 2018;73(7):863\u201374.","journal-title":"Anaesthesia"},{"issue":"2","key":"7594_CR22","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1097\/ALN.0000000000000756","volume":"123","author":"TG Monk","year":"2015","unstructured":"Monk TG, Bronsert MR, Henderson WG, Mangione MP, Sum-Ping ST, Bentt DR, et al. Association between intraoperative hypotension and hypertension and 30-day postoperative mortality in noncardiac surgery. Anesthesiology. 2015;123(2):307\u201319.","journal-title":"Anesthesiology"},{"issue":"5","key":"7594_CR23","doi-asserted-by":"publisher","DOI":"10.1016\/j.heliyon.2023.e15997","volume":"9","author":"J Cai","year":"2023","unstructured":"Cai J, Tang M, Wu H, Yuan J, Liang H, Wu X, et al. Association of intraoperative hypotension and severe postoperative complications during non-cardiac surgery in adult patients: a systematic review and meta-analysis. Heliyon. 2023;9(5):e15997.","journal-title":"Heliyon"},{"key":"7594_CR24","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1186\/s13741-016-0036-1","volume":"5","author":"A Wickham","year":"2016","unstructured":"Wickham A, Highton D, Martin D. Care of elderly patients: a prospective audit of the prevalence of hypotension and the use of BIS intraoperatively in 25 hospitals in London. Perioper Med (Lond). 2016;5:12.","journal-title":"Perioper Med (Lond)"},{"key":"7594_CR25","unstructured":"Hendrix JM, Kramer J: Anesthesia Inhalation Agents and Their Cardiovascular Effects. In: StatPearls. edn. Treasure Island (FL): StatPearls Publishing. Copyright \u00a9 2025, StatPearls Publishing LLC.; 2025."},{"issue":"1","key":"7594_CR26","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1097\/01.anes.0000296071.19434.1e","volume":"108","author":"TG Monk","year":"2008","unstructured":"Monk TG, Weldon BC, Garvan CW, Dede DE, van der Aa MT, Heilman KM, et al. Predictors of cognitive dysfunction after major noncardiac surgery. Anesthesiology. 2008;108(1):18\u201330.","journal-title":"Anesthesiology"},{"issue":"3","key":"7594_CR27","doi-asserted-by":"publisher","first-page":"658","DOI":"10.1097\/ALN.0b013e3182472320","volume":"116","author":"JB Bijker","year":"2012","unstructured":"Bijker JB, Persoon S, Peelen LM, Moons KG, Kalkman CJ, Kappelle LJ, et al. Intraoperative hypotension and perioperative ischemic stroke after general surgery: a nested case-control study. Anesthesiology. 2012;116(3):658\u201364.","journal-title":"Anesthesiology"},{"issue":"2","key":"7594_CR28","doi-asserted-by":"publisher","first-page":"522","DOI":"10.1213\/ANE.0000000000001486","volume":"123","author":"S Norepinephrine","year":"2016","unstructured":"Norepinephrine S. Rather Than Phenylephrine, Be Considered the Primary Vasopressor in Anesthetic Practice?: Erratum. Anesth Analg. 2016;123(2):522.","journal-title":"Anesth Analg"},{"issue":"2","key":"7594_CR29","doi-asserted-by":"publisher","first-page":"410","DOI":"10.1213\/ANE.0000000000005811","volume":"134","author":"VM Aykanat","year":"2022","unstructured":"Aykanat VM, Myles PS, Weinberg L, Burrell A, Bellomo R. Low-concentration norepinephrine infusion for major surgery: a safety and feasibility pilot randomized controlled trial. Anesth Analg. 2022;134(2):410\u20138.","journal-title":"Anesth Analg"},{"issue":"1","key":"7594_CR30","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-020-76983-6","volume":"10","author":"CN Fan","year":"2020","unstructured":"Fan CN, Yang SJ, Shih PY, Wang MJ, Fan SZ, Tsai JC, et al. Comparing effects of intraoperative fluid and vasopressor infusion on intestinal microcirculation. Sci Rep. 2020;10(1):19856.","journal-title":"Sci Rep"}],"container-title":["BMC Geriatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12877-026-07594-5","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12877-026-07594-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12877-026-07594-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T13:03:29Z","timestamp":1781874209000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12877-026-07594-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,2]]},"references-count":30,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["7594"],"URL":"https:\/\/doi.org\/10.1186\/s12877-026-07594-5","relation":{},"ISSN":["1471-2318"],"issn-type":[{"value":"1471-2318","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,2]]},"assertion":[{"value":"27 November 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 April 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This trial strictly adhered to the principles stipulated in the Declaration of Helsinki 2024 and was approved by the Ethics Committee of Qilu Hospital, Shandong University (KYLL-202406\u2013008-2). Written informed consent forms from all participants and\/or their legal representatives will be obtained. Researchers must immediately report all serious adverse events to the sponsor (the corresponding author in the trial) and notify the ethics committee accordingly. The sponsor is responsible for conducting continuous safety evaluations of the study drug (norepinephrine), terminating the trial in the event of serious adverse events, and compensating participants in the event of any serious adverse event.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"863"}}