Anaesthesia for proximal femoral fracture in the UK: first report from the NHS Hip Fracture Anaesthesia Network*

White, Stuart; Griffiths, R.; Holloway, James B.; Shannon, Aoife M.

doi:10.1111/j.1365-2044.2009.06208.x

Cited by 76 publications

(55 citation statements)

References 15 publications

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“…Nationally, as 50% of hip fracture repairs are performed under general anaesthesia [11], we estimate that anaesthesia for hip fracture repair costs the UK £18 million annually. Yet in a questionnaire of anaesthetic intent for hip fracture repair, Sandby-Thomas et al [23] found that 72% of 155 trauma anaesthetists preferred regional anaesthesia.…”

Section: Discussionmentioning

confidence: 99%

Cost estimates of spinal versus general anaesthesia for fractured neck of femur surgery

Chakladar¹,

White²

2010

Anaesthesia

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SummaryIt remains uncertain whether spinal anaesthesia is preferable to general anaesthesia for surgical repair of hip fracture, but one determining factor is the comparative cost. A detailed cost analysis relating to 20 consultants' intended anaesthetic practice (which provided information of consumables used) and data from the Brighton Hip Fracture Database was performed to quantify any difference in the costs of administering spinal versus general anaesthesia for patients with hip fracture. Although spinal anaesthesia took significantly longer to administer (mean (SD) time 31 (15) min vs 27 (16) min; p < 0.0001), the mean (SD) cost of spinal anaesthesia (£193.81 (37.49)) was significantly less than the cost of general anaesthesia (£270.58 (44.68); p < 0.0001). The mean percentage cost of anaesthesia was 3.8% of hospital income per hip fracture, and personnel contributed approximately 46% of this cost. While such considerations indicate that spinal anaesthesia is financially preferable, it is unknown whether differential clinical outcomes between regional and general anaesthesia may offset this apparent monetary advantage.

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Section: Discussionmentioning

confidence: 99%

Cost estimates of spinal versus general anaesthesia for fractured neck of femur surgery

Chakladar¹,

White²

2010

Anaesthesia

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“…Congestive heart failure, myocardial infarction, pneumonia and pulmonary embolism are the most common causes of death [2,36,48,49]. As demonstrated in Table 3, most publications report overall long-term mortality to be low (<8%) with the authors stating, that this is not affected by anaesthetic technique (evidence level I-III; I: n=2) [2,5,10,25,36,37,41,43,44,46,48,49,68,69]. Because the follow-up periods ranged widely from "early death" to "hospital mortality" and "different time periods up to 1 year", this review defines short-term mortality as "mortality ≤1 month" and long-term mortality as "mortality from 3-month up to 1 year".…”

Section: Mortalitymentioning

confidence: 99%

“…Many clinicians declare a preference for regional over general anaesthesia [10]. Nevertheless, more than two thirds of orthopaedic surgeons surveyed in a trial conducted in North America and Europe felt the type of anaesthesia was of little or no importance as a predictor of outcome after femoral neck fracture surgery [11].…”

Section: Introductionmentioning

confidence: 99%

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

Luger

Kammerlander

Gosch³

et al. 2010

Osteoporos Int

173

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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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“…As a consequence, professional guidelines [3][4][5] are unable to recommend one technique over the other with confidence, such that a wide spectrum of techniques continue to be used by anaesthetists [6]. This may explain in part why 30-day postoperative mortality has remained static at approximately 8% for the last five years in spite of national quality improvement initiatives, including data collection and publication by the National Hip Fracture Data-base [7] and 'best practice' tariff uplifts related to performance targets [8].…”

Section: Introductionmentioning

confidence: 99%

Outcome by mode of anaesthesia for hip fracture surgery. An observational audit of 65 535 patients in a national dataset

2014

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Summary Large observational studies of accurate data can provide similar results to more arduous and expensive randomised controlled trials. In 2012, the National Hip Fracture Database extended its dataset to include ‘type of anaesthesia’ data fields. We analysed 65 535 patient record sets to determine differences in outcome. Type of anaesthesia was recorded in 59 191 (90%) patients. Omitting patients who received both general and spinal anaesthesia or in whom an uncertain type of anaesthesia was recorded, there was no significant difference in either cumulative five‐day (2.8% vs 2.8%, p = 0.991) or 30‐day (7.0% vs 7.5%, p = 0.053) mortality between 30 130 patients receiving general anaesthesia and 22 999 patients receiving spinal anaesthesia, even when 30‐day mortality was adjusted for age and ASA physical status (p = 0.226). Mortality within 24 hours after surgery was significantly higher among patients receiving cemented compared with uncemented hemiarthroplasty (1.6% vs 1.2%, p = 0.030), suggesting excess early mortality related to bone cement implantation syndrome. If these data are accurate, then either there is no difference in 30‐day mortality between general and spinal anaesthesia after hip fracture surgery per se, and therefore future research should focus on how to make both types of anaesthesia safer, or there is a difference, but mortality is not the correct outcome to measure after anaesthesia, and therefore future research should focus on differences between general and spinal anaesthesia. These could include more anaesthesia‐sensitive outcomes, such as hypotension, pain, postoperative confusion, respiratory infection and mobilisation.

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Anaesthesia for proximal femoral fracture in the UK: first report from the NHS Hip Fracture Anaesthesia Network*

Cited by 76 publications

References 15 publications

Cost estimates of spinal versus general anaesthesia for fractured neck of femur surgery

Cost estimates of spinal versus general anaesthesia for fractured neck of femur surgery

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

Outcome by mode of anaesthesia for hip fracture surgery. An observational audit of 65 535 patients in a national dataset

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