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

Abstract

BackgroundHip fracture is a trauma of the elderly. The worldwide number of patients in need of surgery after hip fracture will increase in the coming years. The 30-day mortality ranges between 4 and 14%. Patients’ outcome may be improved by anaesthesia technique (general vs. neuraxial anaesthesia). There is a dearth of evidence from randomised studies regarding to the optimal anaesthesia technique. However, several large non-randomised studies addressing this question have been published from the onset of 2010.MethodsTo compare the 30-day mortality rate, in-hospital mortality rate and length of hospital stay after neuraxial (epidural/spinal) or general anaesthesia in hip fracture patients (≥ 18 years old) we prepared a systematic review and meta-analysis. A systematic search for appropriate retrospective observational and prospective randomised studies in Embase and PubMed databases was performed in the time-period from 01.01.2010 to 21.11.2016. Additionally a forward searching in google scholar, a level one reference list searching and a formal searching of trial registries was performed.ResultsTwenty retrospective observational and three prospective randomised controlled studies were included. There was no difference in the 30-day mortality [OR 0.99; 95% CI (0.94 to 1.04), p = 0.60] between the general and the neuraxial anaesthesia group. The in-hospital mortality [OR 0.85; 95% CI (0.76 to 0.95), p = 0.004] and the length of hospital stay were significantly shorter in the neuraxial anaesthesia group [MD -0.26; 95% CI (−0.36 to −0.17); p < 0.00001].ConclusionNeuraxial anaesthesia is associated with a reduced in-hospital mortality and length of hospitalisation. However, type of anaesthesia did not influence the 30-day mortality. In future there is a need for large randomised studies to examine the association between the type of anaesthesia, post-operative complications and mortality.

Risk factors for extended length of stay following hip fracture surgery: A retrospective cohort study of patients aged 90 years and over in China

“…However, it is important to note that most of the very elderly patients in our study received regional anaesthesia (76%). This is in line with the general trend of the guidelines and literature [4][5][6][7] requirements for hip joint surgery in elderly patients. Some studies [14,15] suggest that compared with general anaesthesia, regional anaesthesia reduces the incidence of postoperative adverse outcomes.…”

Hip fracture outcomes in patients with chronic obstructive pulmonary disease

“…11 In this cohort, fewer patients with COPD received GA, potentially because of co-morbid chest disease altering the riskebenefit judgement about the modality of anaesthesia. In previous studies, little, if any, difference in mortality has been observed between the two modalities 12 ; however, RA has been previously associated with better mortality outcomes specifically in patients with COPD 5 as observed here, although not apparent until 1 yr. This temporal dissociation makes it difficult to attribute the mortality difference directly to the choice of anaesthetic.…”

Headache Characteristics in Geriatric Age Group According to Ichd-3 Beta Version

“…An increased mFI was correlated with an increased mortality rate, which suggests that patient condition worsens as the mFI increases in each follow-up evaluation. Femoral fracture is associated with a substantial risk of mortality and morbidity with approximately 1%-6% of patients dying within 30 days of admission (10,11). In this study, the hospital mortality rate was 3.8%, and the 30-day mortality rate was 9.8%.…”

“…Frailty is a known independent factor associated with postoperative mortality and morbidity as well as the length of hospital stay and has been shown to increase the risk of mortality. Patients with femoral fracture represent an elderly group with varied levels of frailty (10)(11)(12). In our patient population, 127 (27.6%) had mFI≥7.…”