Spinal Anesthesia Associated with Better Outcomes after Hip Fracture Repair
Surgical repair of hip fracture is associated with significant postoperative challenges for older patients, with a 90-day mortality rate that has not improved in the last 15 years despite advances in surgical management.
One area of care that could influence outcomes is the type of anesthesia used during the procedure. In a recent study, researchers from the University of Toronto found that compared with general anesthesia, spinal anesthesia may be the better choice for older hip fracture patients.
Their study was presented at the 2018 World Congress on Regional Anesthesia and Pain Medicine in New York.
In the observational propensity-score, matched-pairs cohort study, the researchers identified 2591 patients who had undergone hip fracture fixation between January 1, 2003, and December 31, 2015, at a single institution. They matched 883 patients in the spinal anesthesia group to 883 patients in the general anesthesia group.
Their primary outcome was 90-day in hospital mortality, with secondary outcomes of 30- and 60-day mortality, hospital length-of stay, pulmonary embolism, major blood loss, and major acute cardiac events. After adjusting for variables that can influence a patient’s risk for death after hip fracture surgery, the researchers found:
- Lower 90-day mortality in the spinal anesthesia group (6.3% vs 8.6%; P=<.001)
- Lower incidence of pulmonary embolism in the spinal anesthesia group (0.5% vs 2.3; P=<.001)
- Lower incidence of major blood loss in the spinal anesthesia group (4.8% vs 7.7%; P=<.001)
- No difference in length of stay or major cardiac events
The researchers concluded that the study suggests spinal anesthesia may be preferred over general anesthesia for older patients undergoing hip fracture surgery due to the lower 90-day mortality rate and lower risk of some major complications.
Tierney S, Perlas A, Malhas L, Chan V, Beattie S. The effect of anesthetic technique on mortality and major morbidity following hip fracture fixation. A retrospective, propensity-score matched-pairs cohort study. Presented at the 2018 World Congress on Regional Anesthesia and Pain Medicine, April 19-21, New York, New York.
The study authors have no disclosures relevant to their presentation.