Comparison of Different Anesthetic Techniques on Postoperative Outcomes in Elderly Patients with Hip Fracture

Abstract

A AB BS ST TR RA AC CT T O Ob bj je ec ct ti iv ve e: : Determining the type of anesthesia is a complex medical decision that depends on many factors including co-morbidity, age, type of surgery performed, and the risk of the anesthetic techniques. This study evaluated the effects of anesthesia type on postoperative mortality and morbidity in hip fractures. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : One hundred eighty-five patients older than 60 years who were operated for hip fracture between 2005-2009 were retrospectively analyzed. Patients received general anesthesia (n=67), spinal anesthesia (n=67), or epidural anesthesia (n=51). The clinical features of the patients were obtained from the hospital records. Morbidity outcomes were assessed on postoperative day 7. Mortality rates were calculated on postoperative day 7 and postoperative day 30. R Re es su ul lt ts s: : There were no significant differences between the three groups with regard to intraoperative blood loss, intraoperative blood transfusion, smoking status, length of stay in hospital, American Society of Anesthesiology (ASA) physical status, and Charlson Comorbidity Index (CCI) (p=0.393, p=0.088, p=0.369, p=0.228, p=0.491, p=0.371 respectively). Similarly, no difference was detected between the three groups regarding patient mortality rates for day 7 and 30 (p=0.738, p=0.805 respectively). C Co on nc cl lu us si io on n: : No technique was superior to the others. Due to the similar mortality rates among the groups, we suggest that the proper anesthetic technique selected according to the clinical features of the patient combined with adequate monitorization would yield successful results with all three techniques. K Ke ey y W Wo or rd ds s: : Hip fractures; mortality; anesthesia Ö ÖZ ZE ET T A Am ma aç ç: : Anestezi tipinin belirlenmesi, yaş, uygulanacak cerrahi tipi ve anestezi tekniklerinin riski gibi birçok faktörün göz önüne alınmasını gerektiren, kompleks bir tıbbi karardır. Bu çal-ışmada, kalça kırıklarında anestezi tipinin cerrahi sonrası mortalite ve morbidite üzerindeki etkileri değerlendirilmiştir. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Çalışmada, 2005-2009 yılları arasında kalça kırığı operasyonu geçiren 60 yaş üzeri 185 hasta retrospektif olarak analiz edilmiştir. Hastalara genel anestezi (n=67), spinal anestezi (n=67) ve epidural anestezi (n=51) yöntemlerinden biri uygulanmıştır. Hastalara ait klinik bilgiler hastane kayıtlarından elde edilmiştir. Morbidite sonuç-ları operasyon sonrası yedinci günde değerlendirilmiştir. Mortalite oranı ise operasyon sonrası 7. ve 30. günlerde hesaplanmıştır. B Bu ul lg gu ul la ar r: : Her üç grupta cerrahi sırasındaki kan kaybı ve kan transfüzyonu, sigara içme durumu, hastanede kalış süresi, American Society of Anesthesiology (ASA) skoru ve Charlson morbidite indeksi skoru açısından anlamlı bir fark bulunmamıştır (sırasıyla p=0,393, p=0,088, p=0,369, p=0,228, p=0,491, p=0,371). Hastaların 7. ve 30. günlerdeki mortalite oranları açısından gruplar arasında anlamlı bir f...

Anesthetic Techniques in Octogenarians and Older Undergoing Orthopedic Surgery for Hip Fracture

“…Additionally, they found the postoperative 30-day mortality rate and length of hospital stay were similar between general and spinal anesthesia. Besides, the rates of postoperative 7 th and 30 th -day mortality were similar between the three anesthetic techniques such as general anesthesia, spinal anesthesia, and epidural anesthesia in elderly patients with hip fracture [21]. In the current study, the rates of postoperative mortality were similar between each anesthetic technique such as general anesthesia, spinal anesthesia, CSEA, and PNB.…”

“…But, the studies compared with general anesthesia and regional anesthesia reported that intraoperative blood transfusion requirements were similar between the groups [11,12,19,20]. In addition, intraoperative estimated blood loss and transfusion requirement were similar in general anesthesia, spinal anesthesia or epidural anesthesia [21]. In the current study, intraoperative blood transfusion requirements were similar in octogenarians under general anesthesia, spinal anesthesia, and CSEA.…”

“…It is well known that, the short length of postoperative hospital stay is one of the advantages of regional anesthesia [1,19]. But, it was similar for orthopedic surgical procedures in patients under general anesthesia or regional anesthesia [11,14,20,21]. In this current study, the length of postoperative hospital stay was higher in patients applied general anesthesia than in patients applied other anesthetic techniques, but this difference was not significant statistically.…”

“…The rates of postoperative 7 and 30 day mortality were changed about 3.5% [21,23] and from 7.4% to 9.9% [3,11], respectively. In the current study, the postoperative rate of mortality was slightly higher than the literature.…”

General vs. neuraxial anaesthesia in hip fracture patients: a systematic review and meta-analysis

“…; p  < 0.001, LOS: 9 days vs. 8 days, p  = 0.04); overall mortality: (5/167 [3%] vs. 2/168 [1.2%]; p  = 0.25); overall morbidity: (21/167 [12.6] vs. 9/168 [5.4%]; p  = 0.02)GA increased the risk of postoperative morbidity in octogenarian patients after hip fracture repair. Patients with pre-existing respiratory diseases were especially vulnerable.Seitz et al 2014 [19]Retrospective observational studyGA (inhalational, intravenous, GA combined with epidural or local anaesthesia) vs. SA n  = 20.973 GA = 8.818 (42.1%) SA = 12.155 (57.9%)30-day mortality, 30-day postoperative medical complication, ICU till 7 days after surgery, length of stay (LOS)noneGA vs. SA: 30-day mortality: GA = 691 (11.3%) vs. SA = 665 (10.8%), p  = 0.44; ICU: GA = 371 (6%) vs.SA = 259 (4.2%), P  < 0.001, 30-day postoperative medical complication: GA = 1.165 (19%), SA = 1.169 (19%) p  = 0.92; LOS in days (± standard deviation): GA = 16.1 (20.2), SA = 16.0 (23.6), p  = 0.72GA and SA were associated with similar rates of most postoperative events.Sevtap et al 2013 [20]Retrospective observational studyGA vs. SA vs. EA n  = 185 GA = 67 (36.21%) SA = 67 (36.21%) EA = 51 (27.58%)7-day mortality, 30-day-mortalityBlood loss, blood transfusion, length of stay (LOS)7-day mortality: GA = 3 (4.4%), SA = 2 (2.9%), EA = 1 (1.9%), p  = 0.738; 30-day mortality: GA = 4 (1.4%), SA = 6 (5.9%), EA = 4 (5.8%), p  = 0.805; LOS: GA = 13.6 ± 8.9, SA = 12.5 ± 5.2, EA = 15.7 ± 9.4, p  = 0.228There was no difference in the 7-day and 30-day mortality between the anaesthesia techniques. Further there were no differences in the other factors.Tung et al 2016 [24]Retrospective observational studyGA vs. RA (epidural/spinal) n  = 17.189 GA = 6.063 (35.1%) NA = 11.153 (64.9%)30-day all-cause mortality, 30-day all cause readmission, 30-day specific cause readmission30-day mortality: GA = 104 (1.7%), NA = 189 (1.7%), p  = 0.891, (OR 0.89, 95% CI [0.67 to 1.18], p  = 0.409) 30-day readmission all-cause: GA = 771 (12.8%), NA = 1332 (12%), (OR 0.83, 95% CI 0.75 to0.93, p  = 0.001), Surgical site infection readmission: (OR 0.69, 95% CI 0.49 to 0.97, p  = 0.031)There was no difference in the 30-day mortality between the two groups.…”