Anaesthesia for Hip Fracture: A Survey of Scottish Practice

Dickson, R. E.; Patey, R.

doi:10.1177/003693309904400509

Cited by 5 publications

(2 citation statements)

References 16 publications

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“…Importantly, the current analysis demonstrates the co-dependence of outcome and preoperative delay on the patient's overall state of health, a relationship which invites premature implication of delay itself in poor outcome. Previous findings are mixed in this respect 4,5,7,13,[17][18][19][20] , undoubtedly reflecting a balance between the ill-defined deleterious effects of delaying surgery and the benefits of optimizing treatable medical conditions. Since preoperative delay was dependent on ASA status as a predictor of mortality in our analyses, the current work sanctions reasonable time spent carefully optimizing medical conditions.…”

Section: Discussionmentioning

confidence: 99%

Long-term Survival of Surgically Treated Hip Fracture in an Australian Regional Hospital

McLeod

Brodie

Fahey

et al. 2005

Anaesth Intensive Care

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This study was undertaken to identify factors influencing outcome in elderly patients operated for hip fracture. In particular, this study examined factors related to mortality at least 30 months post-fracture. Hospital records and death registrations were analysed for 463 patients aged 60 or more years treated for hip fracture at a Queensland regional hospital between 1997 and 2001. The overall mortality for surgically treated patients was 13.7% at 100 days and 24.9% at one year. Patient factors including age, gender, health status and place of residence were the predominant influences on mortality. Non-patient and process factors including delay to surgery, type of operation and type of anaesthetic had minimal impact on mortality. No major determinants of length of hospital stay were identified. Patient health status was the main determinant for surgical delay. Our results confirm the persistently high mortality in this group of patients, and suggest that the main determinants of outcome are patient-rather than process-related.

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Section: Discussionmentioning

confidence: 99%

Long-term Survival of Surgically Treated Hip Fracture in an Australian Regional Hospital

McLeod

Brodie

Fahey

et al. 2005

Anaesth Intensive Care

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“…The majority of patients (74.1%) underwent neuroaxial anesthesia (i.e. spinal or epidural), which represents a somewhat different pattern than that observed in many other regions of the Globe where general anesthesia usually represents a larger share of the anesthetic procedures performed for hip fracture patients (47)(48)(49). The debate over what type of anesthetic procedure is best suited for hip fracture patients does not seem to be resolved.…”

Section: Discussionmentioning

confidence: 97%

Hip Fracture in a Developing Country: A Picture in Need of Change

Vidal¹,

Filho²,

Pinheiro³

et al. 2014

J Aging Res & Lifestyle

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Objectives: To describe the clinical profile, patterns of care and mortality rates of aged patients who have undergone hip fracture surgical repair. Design: Retrospective patient record study. Setting: A public university hospital in Rio de Janeiro, Brazil. Participants: 352 patients aged 60 and older who underwent surgery for hip fracture between 1995-2000. Measurements: Sociodemographic data, type of fracture, cause of fracture, time from fracture to surgery, physical status, Charlson comorbidity index, type of surgery and anesthesia, access to in-hospital physiotherapy, use of antibiotic and thromboembolism prophylaxis, and mortality within one year after hospital admission. Results: Among 352 subjects, 74.4% were women. The mean age overall was 77.3 years. Very long delays from the time of fracture to hospital admission (mean 3 days) and from hospital admission to surgery (mean 13 days) were observed. Most femoral neck fractures (82.7%) were managed by hip arthroplasties, while 92.8% of the intertrochanteric fractures underwent internal fixation procedures. Less than 10% of patients received in-hospital physiotherapy. Mortality rates 30 days, 90 days and one year after hospital admission were 3.4%, 8.0% and 13.4%, respectively. Conclusion: Our study provides evidence within the context of a developing country of major gaps in the quality of care of vulnerable older adults who suffered a hip fracture. Our findings suggest that hip fracture has not been treated as an urgent condition or a priority within the Brazilian public healthcare system. Further research should address current patterns of care for hip fracture in Brazil and in other developing countries.

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

Luger

Kammerlander

Gosch³

et al. 2010

Osteoporos Int

172

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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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Anaesthesia for Hip Fracture: A Survey of Scottish Practice

Cited by 5 publications

References 16 publications

Long-term Survival of Surgically Treated Hip Fracture in an Australian Regional Hospital

Long-term Survival of Surgically Treated Hip Fracture in an Australian Regional Hospital

Hip Fracture in a Developing Country: A Picture in Need of Change

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

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