A retrospective observational study on the types of anaesthesia in hip fracture surgery

Abstract

Background There is no specific recommendation regarding the type of anaesthesia in hip fracture surgery. Objectives This study sought to examine the current local anaesthetic practice (general anaesthesia versus regional anaesthesia (RA)) in hip fracture surgery and to analyse their associations with perioperative outcomes. Methodology A retrospective observational study of hip fracture patients from April to December 2017 was undertaken. Patient characteristics and perioperative outcomes were analysed against the types of anaesthesia using multiple logistic regression. Results One hundred and twelve out of 154 patients (72.7%) had a general anaesthesia. Patients from residential care facilities were more likely to receive general anaesthesia (OR = 2.9, 95% CI: 1.1, 7.4; P = 0.03). There was no significant association between type of anaesthesia and specific postoperative outcomes; however, patients with postoperative delirium and hypotension were more likely to have received general anaesthesia [OR = 1.7, 95% CI: 0.68, 4.38; P = 0.25] and [OR = 1.6, 95% CI: 0.67, 4.04; P = 0.27] respectively). Subgroup analysis showed increased length of stay with patients who underwent general anaesthesia (OR = 1.26, 95% CI:1.04, 1.54; P = 0.02). Conclusion Regional anaesthesia may be considered in patients without contraindications in view of increased risk of postoperative delirium and hypotension, and longer length of stay with general anaesthesia. A larger prospective study is needed to confirm these findings.

Regional versus general anesthesia in older patients for hip fracture surgery: a systematic review and meta-analysis of randomized controlled trials

“…LOS is one of the most widely reported outcomes. Several observational studies have indicated a shorter LOS in patients receiving RA [ 40 , 53 , 54 ]. However, the effect of anesthesia techniques on the LOS was observed to be controversial in systematic reviews [ 14 , 33 , 42 , 55 ].…”

The Effect of General Anesthesia vs. Regional Anesthesia on Postoperative Delirium—A Systematic Review and Meta-Analysis

“…Tables 1 , 2 present the basic characteristics of the included studies. There were nine retrospective ( 17 , 18 , 22 , 25 , 28 – 31 , 35 ), and 12 prospective ( 19 – 24 , 26 , 27 , 32 – 34 , 36 , 37 ) articles, including seven randomized and non-randomized controlled trials, in the prospective studies ( 20 , 23 , 24 , 32 – 34 , 37 ). Male accounted for 50% or more of all patients in 4 trials ( 17 , 22 , 23 , 25 ).…”

“…Male accounted for 50% or more of all patients in 4 trials ( 17 , 22 , 23 , 25 ). The mean or median age of all included patients was 80 years or older in five trials ( 20 , 26 , 31 – 33 ), 70–80 years in seven trials ( 21 , 28 , 29 , 34 – 37 ), 60–70 years in seven trials ( 17 , 18 , 23 – 25 , 27 , 30 ), and younger than 60 years in two trials ( 19 , 22 ). Except that the patients underwent lower limb vascular surgery in two articles ( 23 , 25 ) and uncertain surgeries in one article ( 19 ), the patients underwent orthopedic surgery in the other trials.…”

“…The methods of POD identification included antipsychotic drug use ( 17 , 18 , 22 , 30 ), Confusion Assessment Method for Intensive Care Unit (CAM-ICU) or CAM ( 19 , 21 , 36 , 37 ), DSM-IV criteria ( 24 , 27 ), NEECHAM confusion scale ( 25 ), change in mental state ( 23 ), and Pittsburgh Agitation Scale ( 26 ). Seven articles did not provide a specific diagnostic method of POD ( 20 , 28 , 29 , 31 – 33 , 35 ), and a combination of CAM with DSM-IV criteria ( 34 ).…”

“…We used NOS to assess the risk of bias in observational studies (retrospective and prospective), and all 14 trials obtained seven stars or more, indicating high quality ( Supplementary Table 2 ) ( 17 – 19 , 21 , 22 , 25 – 31 , 35 , 36 ). We used the Cochrane Collaboration Risk of Bias Assessment tool to assess the risk of bias in RCTs.…”