Comparison of general anaesthesia and regional anaesthesia in terms of mortality and complications in elderly patients with hip fracture: a nationwide population-based study

Sep 11, 2019BMJ open

Mortality and complications after hip fracture in elderly patients comparing general and regional anesthesia in a nationwide study

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Abstract

Among 96,289 elderly patients who underwent hip fracture surgery, regional anaesthesia (RA) was associated with lower 30-day mortality compared to general anaesthesia (GA).

Postoperative mortality rates were 2.24% for RA and 2.55% for GA, with a statistically significant difference (p=0.0047).
The incidence of postoperative delirium requiring medication was 20.27% in the RA group compared to 22.77% in the GA group (p<0.0001).
Patients receiving RA had a lower rate of intensive care unit admissions (22.1% vs 31.47%, p<0.0001).
Ventilator care was required for 1.73% of patients in the RA group versus 4.72% in the GA group, also showing a significant difference (p<0.0001).

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OBJECTIVE: To evaluate the effects of anaesthesia on postoperative outcome in elderly patients who underwent hip fracture surgery.

SETTING: Nationwide National Health Insurance Sharing Service database of Korea.

PARTICIPANTS: All patients aged ≥65 years old who underwent hip fracture surgery, covered by the Korean National Health Insurance, between 1 January 2009 and 31 December 2015.

INTERVENTIONS: Hip fracture surgery under general anaesthesia (group GA) or regional anaesthesia (group RA), with a principal diagnosis of femoral fracture.

PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was the anaesthetic-type effect on 30-day mortality and the secondary outcome was postoperative delirium requiring pharmacological intervention.

RESULTS: Among the 96 289 patients who underwent hip fracture surgery, 25 593 and 70 696 patients received GA and RA, respectively. After propensity score matching, 25 593 remained in each group. Postmatching mortality was lower in the RA than in the GA group (574 (2.24%) vs 654 (2.55%), p=0·0047, 95% CI -0.0099 to 0.0159). Delirium incidence was lower in the RA than in the GA group (5187 (20.27%) vs 5828 (22.77%), p<0·0001, 95% CI 0.019 to 0.045). The incidence of intensive care unit stay and ventilator care was lower in the RA than in the GA group (5838 (22.1%) vs 8055 (31.47%), p<0·0001, 95% CI 0.046 to 0.070 and 459 (1.73%) vs 1207 (4.72%), p<0·0001, 95% CI -0.0024 to 0.023, respectively).

CONCLUSION: RA was associated with better outcomes than GA, in terms of mortality, delirium, intensive care unit admission and ventilator care, in elderly patients who underwent hip fracture surgery.

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Comparison of general anaesthesia and regional anaesthesia in terms of mortality and complications in elderly patients with hip fracture: a nationwide population-based study

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