Acute hip fracture surgery anaesthetic technique and 30-day mortality in Sweden 2016 and 2017: A retrospective register study

Abstract

Background: Hip fractures affect 1.6 million patients yearly worldwide, often elderly with complex comorbidity. Mortality following surgery for acute hip fracture is high and multifactorial; high age, comorbidities and complication/deterioration in health following surgery. Whether the anaesthesia technique affects the 30-day mortality rate has been studied widely without reaching a consensus. The primary aim of this study was to determine anaesthetic techniques used in Sweden and their impact on the 30-day mortality rate in elderly undergoing acute hip fracture surgery. Other aims were to study the impact of age, gender, ASA class, fracture type and delay in surgery on the 30-day mortality rate. Methods: Data from 13,649 patients ≥50 years old who had undergone acute hip fracture surgery and been reported to Swedish perioperative register (SPOR) between 2016 and 2017 were analysed. Results: The most commonly used anaesthetic technique was neuraxial anaesthesia (NA; 11,257, 82%), followed by general anaesthesia (GA; 2,190, 16%) and combined general and neuraxial anaesthesia (CA; 202, 1.5%) out of the 13,649 studied. The 30-day mortality rate was 7.7% for the entire cohort; GA 7.8%, NA 7.7% and CA 7.4%. Mortality was higher in elderly patients, those with a high ASA class, pertrochanteric fracture and males. Conclusions: The present study showed that NA is by far the most common anaesthetic technique for acute hip fracture surgery in Sweden. However, the anaesthetic technique used during this type of surgery had no impact on the 30-day mortality rate in patients. Increasing age, ASA class and male gender increased the 30-day mortality.

Trends in Hip Fracture Incidence, Length of Hospital Stay, and 30-Day Mortality in Sweden from 1998–2017: A Nationwide Cohort Study

“…First, although hospitals are staffed by highly experienced and educated personnel, the observational design of this study means that we cannot precisely determine to which extent a longer LOS would reduce 30-day mortality, for example in frail men aged 90 and above. Second, we lacked certain covariates of importance, such as an adequate measure of the patient's health status at admission, which may have changed during the study period, as well as data on type of hospital and post-anesthesia care unit LOS, which may influence the 30-day mortality estimates [36,37]. Third, there were some interesting observations with respect to trends in operation techniques, such as a shift toward use of intramedullary nails for intertrochanteric fractures and toward prosthesis for femoral neck fractures.…”

Does early surgery prevent Postoperative ICU admission after surgery for the fracture of the hip. Nested case control study of 911 patients

“…On univariate analysis, we found that gender had a significant impact on post-op ICU stay as females were less likely to be admitted into ICU despite accounting for a greater number of hip fractures. This is one of the widely reported associations in literature which state that men have higher rates of mortality and morbidity [ [26] , [27] , [28] , [29] , [30] ]. General anesthesia also significantly impacted postoperative ICU admission although this association was not observed on multivariate analysis.…”

Predictors of In-Hospital Mortality in Older Adults Undergoing Hip Fracture Surgery: A Case–Control Study

“…Waesberghe et al performed a meta-analysis and examined the outcomes of general and neuraxial (spinal and epidural) anaesthesia in patients with hip fracture and identified significantly lower rates of in-hospital mortality among the neuraxial anaesthesia group (OR .85, P = .004) but no difference in 30-day mortality rate between patients who received these two types of anaesthesia. 25 Moreover, two other retrospective cohort studies that focused on older adults with hip fracture also reported no difference in 30day mortality rates between these two types of anaesthesia, 26,27 and another study reported that spinal anaesthesia was associated with fewer and less severe adverse effects. 27 In fact, an increased use of spinal anaesthesia over general anaesthesia in older adults with hip fracture has already been observed, which may be attributable to lower interventional morbidity in older patients with frailty.…”