Influence of Anaesthesia on Mobilisation following Hip Fracture Surgery: An Observational Study

Abstract

Background Anaesthetic technique can influence mortality and morbidity following hip fracture surgery. However, its influence on postoperative mobilisation is not clear. In this study, we evaluated the influence of anaesthetic technique on postoperative mobilisation. Methods In this prospective observational study, we included all consecutive patients who underwent surgery for hip fracture between 1 January 2012 and 31 December 2013 at our institution. Any patients who died prior to mobilisation or who could not be followed up after surgery were excluded. Data was collected on demographics, clinical characteristics, anaesthesia technique and surgical factors, and date and time of admission, operation, first mobilisation and discharge. Results Of the 1040 patients included in the analysis, 264 received general anaesthesia only (Group GA), 322 received general anaesthesia with regional anaesthesia (Group GARA), and 454 received central neuraxial blockade anaesthesia with or without sedation (Group CNB). There was no significant difference in age (p = 0.56), sex (p = 0.23), number of comorbidities (p = 0.06), residential status (p = 0.18), time to surgery (p = 0.10) and length of hospital stay (p = 0.30) between the three groups. There was a statistically significant difference in ASA grade (p = 0.01), implant type used (p = 0.04), grade of operating surgeon (p = 0.02) and grade of anaesthetist during surgery (p = 0.004) among the three groups. Patients in Group GARA had a median time-to-first mobilisation of 23.8 hours after surgery, compared to 24.1 hours in Group GA and 24.3 hours in Group CNB. This difference was not statistically significant after controlling for confounding factors (p = 0.45). Conclusion Our results show that anaesthetic technique does not influence time-to-first mobilisation after hip fracture surgery.

Effect of regional versus general anaesthesia on postoperative delirium in elderly patients undergoing surgery for hip fracture: a systematic review

“…However, one RCT found that patients given RA were slower to be discharged from PACU (mean time to discharge GA 35.04 min (SD 3.39) vs RA 41.26 min (SD 8.37), p=0.001) 111. No significant differences were found in the non-randomised studies regarding time to ambulation,103 112 113 walking speed,62 time to rise from chair,42 mean Barthel’s score73 or ambulation at 3, 6 and 12 months post surgery 45 105. Overall results may suggest a small benefit from RA for immediate post-anaesthetic mobilisation.…”