Impact of Anesthesia on Hospital Mortality and Morbidities in Geriatric Patients Following Emergency Hip Fracture Surgery

Feb 21, 2018Journal of orthopaedic trauma

How Anesthesia Affects Death and Complications in Older Patients After Emergency Hip Fracture Surgery

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Abstract

Among 16,695 patients aged 65 and older undergoing hip fracture surgery, the hazard ratio for in-hospital mortality with general anesthesia was 1.38 compared to regional anesthesia.

In-hospital mortality was higher with general anesthesia (GA) compared to regional anesthesia (RA), with a hazard ratio of 1.38.
The conversion from regional to general anesthesia (Cv) showed an even greater hazard ratio of 2.23 for in-hospital mortality.
Time to death was associated with GA at a ratio of 0.97, while Cv had a time ratio of 0.89.
Length of stay (LOS) before discharge was slightly increased with GA, showing a time ratio of 1.01.
Discharge to home was less likely with GA, indicated by a hazard ratio of 0.86, while the Cv group showed no significant results.

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OBJECTIVES: To determine the impact of anesthesia type on in-hospital mortality and morbidity for geriatric fragility hip fracture surgery.

DESIGN: Retrospective cohort study.

SETTING: Integrates health care delivery system across 38 facilities in the United States.

PATIENTS/PARTICIPANTS: We identified 16,695 patients 65 years of age and older who underwent emergent hip fracture repairs between 2009 and 2014 through the Kaiser Permanente hip fracture registry and excluded pathologic or bilateral fractures.

INTERVENTION: Hip fracture surgery with general or regional anesthesia.

MAIN OUTCOMES MEASURES: Data on in-hospital mortality, time to death, discharge disposition, and length of stay (LOS) were analyzed among the following anesthesia types: general anesthesia (GA), regional anesthesia (RA), and intraoperative conversions from regional to general (Cv).

RESULTS: Compared with RA, the hazard ratio for GA for in-hospital mortality was 1.38 and 2.23 for the Cv group; the time ratio for GA-associated time to death was 0.97 and 0.89 for the Cv group. The GA-associated time ratio for LOS before discharge was 1.01, and the hazard ratio for home discharge was 0.86, but no significance was found with the Cv group.

CONCLUSIONS: RA may offer advantages over GA for fragility hip fracture surgeries when possible. In-hospital mortality, time to death, increased LOS, and discharge to an institute rather than home were all adversely influenced by GA. Furthermore, the previously understudied Cv group demonstrated adverse outcomes for in-hospital mortality and time to death.

LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Impact of Anesthesia on Hospital Mortality and Morbidities in Geriatric Patients Following Emergency Hip Fracture Surgery

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