International Journal of Medical Anesthesiology · Aug 2026

Frailty and intraoperative hypotension as interrelated predictors of postoperative outcomes

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This article examines the relationship between frailty and intraoperative hypotension in the context of postoperative outcomes among non-cardiac surgical patients. The study was conducted as a systematic review of scientific publications followed by an analytical synthesis of evidence regarding patient physiological vulnerability, intraoperative hemodynamic instability, and the most significant postoperative complications. Particular attention is paid not to individual risk factors but to their interaction. A comparative analysis of contemporary approaches to frailty assessment, the characteristics of intraoperative hypotension, and their associations with delirium, acute kidney injury, myocardial injury, prolonged hospitalization, hospital readmissions, and mortality was performed. It was found that reduced physiological reserves are associated with increased sensitivity to intraoperative hemodynamic disturbances. At the same time, clinical significance is determined not only by the absolute level of arterial blood pressure. Equally important is the patient’s ability to tolerate periods of relative tissue hypoperfusion. An original conceptual model is proposed that integrates frailty, intraoperative hypotension, and postoperative complications within a unified pathophysiological framework. The model considers intraoperative hypotension as an intermediate mechanism through which the risk associated with diminished physiological reserves is realized. The findings expand current understanding of the mechanisms underlying postoperative outcomes and may be of interest to specialists in anesthesiology, perioperative medicine, and gerontology.

doi.org/10.33545/26643766.2026.v9.i8a.668Open accessMechanisms