Anaesthesia for hip fracture surgery in adults

Guay, Joanne; Parker, Martyn J.; Gajendragadkar, Pushpaj R.; Kopp, Sandra L.

doi:10.1002/14651858.cd000521.pub3

Cited by 238 publications

(155 citation statements)

References 65 publications

(7 reference statements)

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“…An increased mFI was correlated with an increased mortality rate, which suggests that patient condition worsens as the mFI increases in each follow-up evaluation. Femoral fracture is associated with a substantial risk of mortality and morbidity with approximately 1%-6% of patients dying within 30 days of admission (10,11). In this study, the hospital mortality rate was 3.8%, and the 30-day mortality rate was 9.8%.…”

Section: Discussionmentioning

confidence: 59%

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Headache Characteristics in Geriatric Age Group According to Ichd-3 Beta Version

yıldırım¹

2018

tjgeri

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Introduction:Femoral fracture is associated with high geriatric mortality. Frailty is the increased vulnerability to stressors resulting from aging-associated decreases in physiological reserve. We aimed to predict 30-365-day postoperative mortality and morbidity rates using modified frailty index and perioperative characteristics in geriatric femoral fractures.Materials and Method: Using a prospective observational design, data were collected from patients >65 years undergoing femoral fracture surgery from 13 different hospitals in 2016 and 2017. Post-discharge follow-up periods were 30, 90, 180, and 365 days. Age, sex, modified frailty index and anaesthesia types used during surgery were recorded. Renal markers, troponin I and haemoglobin levels were examined preoperatively and postoperatively at 24 and 72 hours.Results: We included 392 patients in this study. The age of the patients were between 65 and 101 (mean, 79±11.9). Median modified frailty index was 5 (interquartile range, 2-7). Increase in modified frailty index increased mortality rate. Mortality rate at postoperative 30 days was 9.8%, while overall study mortality rate was 23%. Spinal anaesthesia was administered in 205 patients (52.3%, most frequent), followed by general in 110 (28.1%), peripheral nerve blocks in 21 (5.4) and spinal-epidural in 43 (11%). Anaesthesia type affected both intensive care unit (p<0.001) and total hospitalization (p<0.012) duration. A logistic regression model revealed that frailty index, preoperative creatinine and centre type were independent mortality predictors.Conclusion: Increased modified frailty index was associated with higher postoperative mortality risk, thus providing an additional way for improving risk stratification. Preoperative creatinine increase and centre types are determining factors in mortality.Keywords: Frail elderly; Geriatrics; Femoral fractures; Anesthesia; Mortality; Morbidity Giriş: Femur kırığı geriatrik popülasyonda yüksek mortalite ile ilişkili ciddi bir durumdur. Kırılganlık, yaşlanmayla ilişkili fizyolojik rezerv azalmalarından kaynaklanan savunmasızlığın klinik olarak artmasıdır. Bu çalışmada geriatrik femur kırığı ameliyatı sonrası 30-365 günlük postoperatif mortalite ve morbidite oranlarını, modifiye kırılganlık indeksi ve perioperatif özellikleri kullanarak öngörmeyi amaçladık.Gereç ve Yöntem: Prospektif, gözlemsel, çok merkezli çalışmada, 2016 ve 2017 yıllarında 13 farklı hastaneden femur kırığı ameliyatı geçiren 65 yaş üstü hastalardan veri toplandı. Taburculuk sonrası belirlenen izlem aralıkları 30, 90, 180 ve 365 gündü. Yaş, cinsiyet, mFİ ve uygulanan anestezi yöntemi kaydedildi. Böbrek belirteçleri, troponin I ve hemoglobin düzeyleri preoperatif ve postoperatif 24 ve 72. saatlerde incelendi.Bulgular: Araştırmaya 392 hasta dahil edildi. Hastaların yaşları 65-101 yıl idi (ortalama 79±11.9). Medyan modifiye kırılganlık indeksi 5 (interquartile range, 2-7) idi. 7); ve artışı ile mortalite oranını yükseldi. Postoperatif 30 günlük mortalite hızı %9.8 iken genel mortalite %23 bulundu. E...

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Section: Discussionmentioning

confidence: 59%

“…Frailty is a known independent factor associated with postoperative mortality and morbidity as well as the length of hospital stay and has been shown to increase the risk of mortality. Patients with femoral fracture represent an elderly group with varied levels of frailty (10)(11)(12). In our patient population, 127 (27.6%) had mFI≥7.…”

Section: Discussionmentioning

confidence: 90%

Headache Characteristics in Geriatric Age Group According to Ichd-3 Beta Version

yıldırım¹

2018

tjgeri

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“…Firstly, the patient had no major contraindications for THR. Regarding the chosen anaesthetic technique, recent works have suggested regional anaesthesia as the main choice for femur and hip fracture surgeries (3,10). Moreover, the spinal anesthesia procedure was performed without any complication or issue.…”

Section: Discussionmentioning

confidence: 99%

Thoracic Unilateral Spinal Cord Injury After Spinal Anaesthesia for Total Hip Replacement: Fate or Mistake?

Costa¹,

Romualdo²,

Eugenio³

et al. 2017

Turk J Anaesth Reanim

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Case Report / Olgu Sunumu Spinal anestezi total kalça protezi ameliyatı için ilk seçenektir ve hafif komplikasyonlarının yanı sıra yaşamı tehdit edecek kadar ciddi komplikasyonları da vardır. Bazı spinal kord iskemisi vakaları tanımlanmış olmasına rağmen, nöroaksiyal anestezi sonrasında nörolojik komplikasyonların insidansı net değildir. Bu çalışmada, total kalça protezi için L2-L3 spinal anestezi uygulamasının ardın-dan gelişen tek taraflı T8-T11 spinal kord iskemi vakası sunulmaktadır. Manyetik rezonans görüntülemesi (MRI) sonucunda, sol paramediyan spinal kord hiperintens T8-T11 sinyal değişikliği bulundu. Hasar ile cerrahi arasında geçici bir epidemiyolojik bağ-lantının varlığı görülmektedir. Yaralanma, yara alanı ile spinal iğ-nenin giriş alanı arasında, anatomik yakınlık olmaksızın meydana geldi. Bu durum, sadece birinin yaralanmayı tek başına belirlemek için yeterli olmayacağı birçok faktörden kaynaklanabilir. Aynı anda hepsinin etkisiyle komplikasyon oluşabilir. Çalışmamızda sonuç öngörülemez ve kaçınılmazdı. Yetersiz tıbbi uygulamadan ziyade beklenmeyen durumlar bu sonuca yol açtılar.Anahtar kelimeler: Spinal kord yaralanmaları, spinal anestezi, kalça protezi artroplastisi, spinal kord iskemisi, iskemik miyelopati Spinal anaesthesia is the most preffered anesthesia technique for total hip replacement, and its complications range from low entity (insignificant) to life threatening. The incidence of neurologic complications after neuraxial anaesthesia is not perfectly clear, although there are several described cases of spinal cord ischaemia. We present a case of unilateral T8-T11 spinal cord ischaemia following L2-L3 spinal anaesthesia for total hip replacement. Magnetic resonance imaging showed a hyperintense T8-T11 signal alteration on the leftside of paramedian spinal cord. A temporal epidemiologic linkage between the damage and the surgery seems to be present. The injury occurred without anatomical proximity between the injury site and the spinal needle entry site. This may be due to multiple contributing factors, each of them is probably not enough to determine the damage by itself; however, acting simultaneously, they could have been responsible for the complication. The result was unpredictable and unavoidable and was caused by unforeseeable circumstances and not by inadequate medical practice.Keywords: Spinal cord injuries, spinal anaesthesia, arthroplasty, hip replacement, spinal cord ischaemia, ischaemic myelopathy Abstract / Öz

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“…In addition, no significant differences were found in the risk of pneumonia (RR = 0.77; 95% CI: 0.45-1.31), myocardial infarction (RR = 0.89; 95% CI: 0.22-3.65), cerebrovascular accident (RR = 1.48; 95% CI: 0.46-4.83), or delirium (RR = 0.85; 95% CI: 0.51-1.40). 50 The review also found a lower rate of DVT in the absence of thromboprophylaxis in regional anesthesia compared with general anesthesia (RR = 0.57; 95% CI: 0.41-0.78); however, this difference disappeared if low-molecular-weight heparin (LMWH) was administered (RR = 0.98; 95% CI: 0.52-1.84). 50 The use of peripheral nerve blocks has improved pain management after hip fracture in a secure manner with numerous potential benefits, including lower objective pain scores compared with usual care and less need for opioid analgesia.…”

Section: Anesthesiamentioning

confidence: 97%

“…50 The review also found a lower rate of DVT in the absence of thromboprophylaxis in regional anesthesia compared with general anesthesia (RR = 0.57; 95% CI: 0.41-0.78); however, this difference disappeared if low-molecular-weight heparin (LMWH) was administered (RR = 0.98; 95% CI: 0.52-1.84). 50 The use of peripheral nerve blocks has improved pain management after hip fracture in a secure manner with numerous potential benefits, including lower objective pain scores compared with usual care and less need for opioid analgesia. [51][52][53] Many forms of peripheral nerve blocks have been reported, and their use can begin in the emergency department (ED) and continue until the postoperative period.…”

Section: Anesthesiamentioning

confidence: 97%

Hip Fracture in the Elderly

Urrutia¹,

Zamora²,

Klaber³

2017

CMGer

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Hip fractures in elderly patients are the most severe form of fragility fractures. They can lead to significant morbidity and mortality; additionally, they have an enormous economic and social burden. Treatment of hip fractures in elderly patients should be based on a prompt initial evaluation, followed by surgical treatment without unnecessary delays under a collaborative effort of a multidisciplinary team. Postoperative care should be started immediately after surgery, and it must include an intensive rehabilitation, as well as treatment of osteoporosis and any other metabolic imbalance. This review incorporates current literature on initial evaluation and definitive management of hip fractures in the elderly and is intended to assist practitioners of different specialties treating these patients.

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Anaesthesia for hip fracture surgery in adults

Cited by 238 publications

References 65 publications

Headache Characteristics in Geriatric Age Group According to Ichd-3 Beta Version

Headache Characteristics in Geriatric Age Group According to Ichd-3 Beta Version

Thoracic Unilateral Spinal Cord Injury After Spinal Anaesthesia for Total Hip Replacement: Fate or Mistake?

Hip Fracture in the Elderly

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