Acute hip fracture surgery anaesthetic technique and 30-day mortality in Sweden 2016 and 2017: A retrospective register study

Abstract

Hip fractures yearly affect 1.6 million patients worldwide, often the elderly with complex comorbidity. Mortality following surgery for acute hip fracture is high. The high mortality rate is multifactorial; high age, comorbidities and complication/deterioration in health following surgery. Whether the anaesthesia technique affects the 30-day mortality rate has been studied widely without reaching a consensus. The primary aim of this study was to determine anaesthetic techniques used in Sweden and their impact on the 30-day mortality rate in the elderly, who underwent acute hip fracture surgery. Other aims were to study the impact of age, gender, ASA class, fracture type and delay in surgery on the 30-day mortality rate. Data from 13,649 patients ≥50 years old who had undergone acute hip fracture surgery and been reported to Swedish perioperative register (SPOR) between 2016 and 2017 were analysed. The most commonly used anaesthetic technique was neuraxial anaesthesia (NA; 11257, 82%), followed by general anaesthesia (GA; 2190, 16%) and combined general and neuraxial anaesthesia (CA; 202, 1.5%) out of the 13,649 studied. The 30-day mortality rate was 7.7% for the entire cohort; GA 7.8%, NA 7.7% and CA 7.4%. Mortality was higher in elderly patients, those with a high ASA class, pertrochanteric fracture and males. The present study showed that NA is by far the most common anaesthetic technique for acute hip fracture surgery in Sweden. However, the anaesthetic technique used during this type of surgery had no impact on the 30-day mortality rate of patients. Increasing age, ASA class and male gender increased the 30-day mortality.

Anaesthesia practice, quality indices including all‐cause 30‐day mortality associate to wrist fracture repositioning and surgery in Sweden: A perioperative register‐based study 2018–2021

“…As expected, higher ASA class and higher age was associated to higher all‐cause patient 30‐day mortality. These results are in line with our previous SPOR‐based study, assessing perioperative mortality following hip fracture repair, although the overall mortality (7.7%) in that patient cohort was far higher 7 . In a study based on the Swedish fracture register covering all distal radius fractures in patients aged ≥18 years between 2015 and 2017, the overall mean age was 62.7 years.…”

Difference in early all-cause mortality among patients having hip arthroplasty a Swedish perioperative registry study 2013–2022

“…The hip fracture group was associated with a 21.5 higher odds ratio for all cause 30-day mortality as compared with the osteoarthritis group in the adjusted model. The mortality among the fracture patients is similar to what was found in an earlier study, assessing all hip fracture surgery 2016 and 2017 [ 25 ]. The mortality following hip arthroplasty in the present study is also in line with a study by Maceroli et al from US [ 26 ].…”

Trends in Hip Fracture Incidence, Length of Hospital Stay, and 30-Day Mortality in Sweden from 1998–2017: A Nationwide Cohort Study

“…First, although hospitals are staffed by highly experienced and educated personnel, the observational design of this study means that we cannot precisely determine to which extent a longer LOS would reduce 30-day mortality, for example in frail men aged 90 and above. Second, we lacked certain covariates of importance, such as an adequate measure of the patient’s health status at admission, which may have changed during the study period, as well as data on type of hospital and post-anesthesia care unit LOS, which may influence the 30-day mortality estimates [ 36 , 37 ]. Third, there were some interesting observations with respect to trends in operation techniques, such as a shift toward use of intramedullary nails for intertrochanteric fractures and toward prosthesis for femoral neck fractures.…”