Evaluation of the effects of two different anesthesia methods on postoperative renal functions in geriatric patients undergoing hip fracture surgery: a prospective randomized trial

Abstract

Aim: The choice of anesthesia management for hip fracture surgery is among the modifiable risk factors that can affect the outcome. This study aims to investigate the effects of two different anesthesia techniques on kidney functions with the RIFLE (Risk, Injury, Failure, Loss, and End-stage renal failure) risk score in patients who were operated on for hip fracture.
 Material and Method: Serum creatinine values lower than 1.5 times (Normal value: 1.2 mg/dL) and glomerular filtration rate (GFR) below 60 mg/dl, over 65 years old, without serious comorbidity, hemoglobin (Hb) value over 9 g/dl 60 patients were included. The demographic data and biochemical parameters of the patients were recorded. The patients were randomized into two groups as spinal anesthesia (Group S) and general anesthesia (Group G). During the surgery, a urinary catheter was applied to the patients and urine output was monitored. Balance liquid electrolyte regimen was applied and after Hb control, an appropriate blood regimen was planned with Hb above 9 g/dl. Postoperatively, patients were followed at 6th, 12th, and 24th hours on the first day, and then at 24-hour intervals in the first postoperative week, and were evaluated with the RIFLE risk scores.
 Results: There was no statistically significant difference between the groups in terms of demographic data, fracture type, laboratory values, and urine volumes (p > 0.05). In the comparison of intragroup urea values, the decrease in the 5th time interval compared to the baseline value was statistically significant in Group G. There was no statistically significant difference between the measurement times in Group S (p > 0.05). Preoperative creatinine values were found to be statistically significantly higher than other measurement times in the patient group in Group S (p < 0.05). In both groups, it was found that all measurement time urine amounts were statistically different from each other (p < 0.05). In comparisons between groups, There was no statistically significant difference in terms of RIFLE risk score and postoperative outcome at all measurement times (p>0.05).
 Conclusion: There is no difference between the anesthesia method applied in hip fracture surgery and the change in renal function of patients, based on RIFLE criteria and laboratory parameters. In addition, a significant improvement in renal functions was observed in both groups, especially during the discharge period, according to preoperative values, which may indicate that the stress response to surgery can be effectively limited in both anesthesia methods.