Study tests link between anesthesia type, complications and mortality after hip fracture surgery

Anesthesia type may affect complications and mortality after hip fracture surgery, according to a new study in the July issue of Anesthesiology. The Perelman School of Medicine at the University of Pennsylvania study tested the association between regional versus general anesthesia, and pulmonary and cardiovascular complications and mortality.

Hip fracture is a worldwide health problem among older adults. It occurs 1.6 million times each year globally and over 300,000 times each year in the United States. Consequences of hip fracture can be severe, as 20 percent of patients die within the first year of their fracture. Hip fracture also often places a profound economic, social and emotional burden on patients and their families.

"The main goal of our research was to compare in-hospital outcomes between patients who received regional versus general anesthesia for hip fracture," said lead study author Mark D. Neuman, M.D., M.Sc., Assistant Professor of Anesthesiology and Critical Care and a Senior Fellow at the Leonard Davis Institute of Health Economics. "Since survival outcomes after hip fracture have shown limited improvement over the past 10 years in the United States, we attempted to provide evidence that it may be possible to improve outcomes through better care."

Methodology and Findings
Researchers studied more than 18,000 hip fracture discharges and their outcomes from 126 hospitals in New York over a two-year span. Advanced statistical methods were used to adjust for differences in illness severity between patient groups, as well as for hospital-level differences.

Of all the discharges, 29 percent of patients received regional anesthesia (epidural, spinal or nerve block). The rate of respiratory failure in these patients was 3.4 percent, while their rate of pulmonary complications was 6.8 percent. Discharges who received general anesthesia had higher rates of respiratory failure (5 percent) and pulmonary complications (8.1 percent).

The study also found a 29 percent lower adjusted odds of mortality among patients who received regional anesthesia compared to those who received general anesthesia. However, there was no difference in cardiovascular complications.

"Our study provides an initial suggestion that hip fracture outcomes may be improved by promoting more widespread use of regional anesthesia," said Dr. Neuman. "Future research needs to use prospective studies and look at longer-term outcomes. It also should determine the extent to which, and among whom, regional anesthesia may improve outcomes of hip fracture care."

Given the high rate of complications and mortality associated with hip fracture, the study highlights an important opportunity to improve outcomes among an older population of vulnerable surgical patients.

Source: Anesthesiology