Mortality after spinal and general anaesthesia for surgical fixation of hip fractures

Sutcliffe, Anne J.; Parker, Martyn J.

doi:10.1111/j.1365-2044.1994.tb03430.x

Cited by 56 publications

(18 citation statements)

References 18 publications

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“…As previously discussed, these studies had methodological flaws and/or many do not reflect current anaesthesiological practice and/or drugs are not longer available [5,6,14]. Even large trials may not have enough power to detect differences in outcomes between regional and general anaesthesia [41][42][43]. For this reason also, observational studies of lower-level evidence were included to draw a more pronounced conclusion although these citations have to be more critically addressed.…”

Section: Quality Of Published Workmentioning

confidence: 99%

“…As a secondary result, three studies [22,51,88] noted an association between spinal anaesthesia and shortened time to surgery (evidence level III). Studies older than 20 years reported that time to surgery is unrelated to the anaesthetic technique (evidence level I-IV; I: n=3) [36,37,42,47,48,56,68]. Therefore, it remains to be investigated whether other factors might also be responsible for this possible association.…”

Section: Time To Surgerymentioning

confidence: 99%

See 1 more Smart Citation

Neuroaxial versus general anaesthesia in geriatric patients for hip fracture surgery: does it matter?

Luger

Kammerlander

Gosch³

et al. 2010

Osteoporos Int

173

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The influence of the mode of anaesthesia on outcome of geriatric patients with hip fractures is a controversial issue in the medical literature. In the light of an ageing society, a conclusive answer to this question is of growing importance. The purpose of this review was to assess the effect of neuroaxial and general anaesthesia on mortality and morbidity in geriatric patients sustaining a hip fracture. Following a current literature search within the Pubmed and Cochrane database (1967-2010), 34 randomised controlled trials, 14 observational studies and eight reviews/meta-analysis publications were included. Potentially outcome-influencing factors such as mortality, deep vein thrombosis, pulmonary embolism, postoperative confusion and other anaesthesia-related outcomes were evaluated. After analysing the current literature with 56 references, covering 18,715 patients with hip fracture, it can be concluded that spinal anaesthesia is associated with significantly reduced early mortality, fewer incidents of deep vein thrombosis, less acute postoperative confusion, a tendency to fewer myocardial infarctions, fewer cases of pneumonia, fatal pulmonary embolism and postoperative hypoxia. General anaesthesia has the advantages of having a lower incidence of hypotension and a tendency towards fewer cerebrovascular accidents compared to neuroaxial anaesthesia. Otherwise, general anaesthesia and respiratory diseases were significant predictors of morbidity in hip fracture patients. These data suggest that regional anaesthesia is the preferred technique, but the limited evidence available does not permit a definitive conclusion to be drawn for mortality or other outcomes. For hip fracture surgery, the choice of anaesthesia (general or neuroaxial) is made by the anaesthesiologist and is based on the patient's preference, comorbidities, potential general postoperative complications and the clinical experience of the anaesthesiologist. The overall therapeutic approach in hip fracture care should be determined jointly by the orthopaedic surgeon, the geriatrician and the anaesthesiologist (multidisciplinary approach).

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Section: Quality Of Published Workmentioning

confidence: 99%

Section: Time To Surgerymentioning

confidence: 99%

Neuroaxial versus general anaesthesia in geriatric patients for hip fracture surgery: does it matter?

Luger

Kammerlander

Gosch³

et al. 2010

Osteoporos Int

173

View full text Add to dashboard Cite

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“…The FIM includes 3 subscales of physical functioning: (1) locomotion (a 2-item subscale [range, [2][3][4][5][6][7][8][9][10][11][12][13][14] focusing on walking and climbing stairs), (2) self care (a 6-item scale [range, of self-care activities, including bathing and dressing), and (3) transferring (a 3-item scale [range, [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] focusing on transfers from the bed, toilet, and tub). Each item was scored between 1 (for complete dependence) and 7 (for complete independence) using specific criteria.…”

Section: Data Collection and Study Outcomesmentioning

confidence: 99%

“…16 We additionally included information from recently completed studies from our group. 8,10,[17][18][19] We found that extensive randomized trial evidence was available for only 3 issues at best-antibiotic prophylaxis, [20][21][22] prevention of thromboembolism,23 -26 and nutritional support.27 -30 For several issues (urinary tract care and collaborative rehabilitation), the randomized trials were fewer and smaller. 31 Similarly, there were few randomized trials available for a number of important clinical topics including timing of surgery, early mobilization, and intensity of physical therapy, although some well-conducted observational studies were available.…”

Section: Deriving Processes Measures Of the Quality Of Carementioning

confidence: 99%

Effect of Inpatient Quality of Care on Functional Outcomes in Patients With Hip Fracture

Siu¹,

Boockvar²,

Penrod³

et al. 2006

Medical Care

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Objectives-We sought to examine the relationship between functional outcome and process of care for patients with hip fracture.Research Design and Participants-We undertook a prospective cohort study in 4 hospitals of 554 patients treated with surgery for hip fracture.Measurements-Information on patient characteristics and processes of hospital care collected from the medical record, interviews, and bedside observations. Follow-up information obtained at 6 months on function (using the Functional Independence Measure [FIM]), survival, and readmission.Results-Individual processes of care were generally not associated with adjusted outcomes. A scale of 9 processes related to mobilization was associated with improved adjusted locomotion (P = 0.006), self care (P = 0.022), and transferring (P = 0.007) at 2 months, but the benefits were smaller and not significant by 6 months. These processes were not associated with mortality. The predicted value for the FIM locomotion measure (range, 2-14) at 2 months was 5.9 (95% confidence interval 5.4-6.4) for patients at the 10th percentile of performance on these processes compared with 7.1 (95% confidence interval 6.6, 7.6) at the 90th percentile. Patients who experienced no hospital complications and no readmissions retained the benefits in locomotion at 6 months. Anticoagulation processes were associated with improved transferring at 2 months (P = 0.046) but anticoagulation and other processes of care were not otherwise associated with improved function.

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“…Fifteen of these were subsequently excl uded. 13,14,17,19,20,21,24,26,28,[31][32][33]36,40,43 The reasons for their exclusion can be seen in Figure 1. Thus, 17 articles with the potential to answer our research question were identified.…”

Section: Study Selectionmentioning

confidence: 99%

Neuraxial anesthesia for orthopedic surgery: systematic review and meta-analysis of randomized clinical trials

2013

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CONTEXT AND OBJECTIVE: Taking the outcome of mortality into consideration, there is controversy about the beneficial effects of neuraxial anesthesia for orthopedic surgery. SciELO, EMBASE (1974 to November 2012 and reference lists of the studies included. Only randomized controlled trials were included. RESULTS: Out of 5,032 titles and abstracts, 17 studies were included. There were no statistically significant differences in mortality (risk difference, RD: -0.01; 95% confidence interval, CI: -0.04 to 0.01; n = 1903), stroke (RD: 0.02; 95% CI: -0.04 to 0.08; n = 259), myocardial infarction (RD: -0.01; 95% CI: -0.04 to 0.02; n = 291), length of hospitalization (mean difference, -0.05; 95% CI: -0.69 to 0.58; n = 870), postoperative cognitive dysfunction (RD: 0.00; 95% CI: -0.04 to 0.05; n = 479) or pneumonia (odds ratio, 0.61; 95% CI: 0.25 to 1.49; n = 167). CONCLUSION: So far, the evidence available from the studies included is insufficient to prove that neuraxial anesthesia is more effective and safer than general anesthesia for orthopedic surgery. However, this systematic review does not rule out clinically important differences with regard to mortality, stroke, myocardial infarction, length of hospitalization, postoperative cognitive dysfunction or pneumonia. CONCLUSÃO: Até o momento, as evidências são insuficientes nos estudos incluídos para provar que AN é mais efetiva e segura do que AG para cirurgias ortopédicas. Esta revisão sistemática não descartou diferenças clínicas importantes para mortalidade, acidente vascular encefálico, infarto miocárdico, tempo de internação, disfunção cognitiva pós-operatória e pneumonia. RESUMO IMSc. Professor,

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Mortality after spinal and general anaesthesia for surgical fixation of hip fractures

Cited by 56 publications

References 18 publications

Neuroaxial versus general anaesthesia in geriatric patients for hip fracture surgery: does it matter?

Neuroaxial versus general anaesthesia in geriatric patients for hip fracture surgery: does it matter?

Effect of Inpatient Quality of Care on Functional Outcomes in Patients With Hip Fracture

Neuraxial anesthesia for orthopedic surgery: systematic review and meta-analysis of randomized clinical trials

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