Aspiration pneumonia and anesthesia techniques in hip fracture surgery in elderly patients: A retrospective cohort study using administrative data

Abstract

Purpose: Aspiration pneumonia is a critical issue. General anesthesia may suppress the airway’s protective reflex. However, aspiration pneumonia is also observed in patients who undergo hip fracture surgery under spinal anesthesia. The aim of this study was to investigate the relationship between anesthesia methods and aspiration pneumonia as well as the predictive factors of aspiration pneumonia in elderly patients undergoing hip fracture surgery. Methods: The medical records of 19,809 patients aged ≥60 years who underwent hip fracture surgery under general or spinal anesthesia were reviewed. After propensity score matching, the anesthesia methods affecting the occurrences of aspiration pneumonia and other complications were investigated via logistic regression and instrumental variable analyses. Predictive factors of aspiration pneumonia were also investigated in all subjects using a multivariable logistic regression analysis. Results: Among the 11,673 general anesthesia patients and 8136 spinal anesthesia patients, aspiration pneumonia occurred in 356 patients (1.8%). Post-propensity score matching the incidences of aspiration pneumonia with general and spinal anesthesia were 1.8% and 1.5%, respectively ( p = 0.158); other pulmonary complications were 1.5% and 1.5%, respectively ( p = 0.893); and the mortality rates were 1.4% and 1.2%, respectively ( p = 0.219). The predictive factors of aspiration pneumonia were advanced age, male sex, lean body, cerebrovascular disease, dementia, and dependency for activities of daily living (eating). Conclusion: Spinal and general anesthesia showed similar incidences of aspiration pneumonia in elderly hip fracture surgery. Regardless of the anesthesia method, great care should be taken, especially in elderly patients with the identified predictive factors.

Effects of general and spinal anesthesia on postoperative rehabilitation in older adults after lower limb surgery: a retrospective cohort study

“…And reducing postoperative complications and hospitalization time are important indicators for accelerating postoperative rehabilitation. There are studies have reported that SA may be associated with a reduced incidence of postoperative complications, including death, deep vein thrombosis, pulmonary complications, and myocardial infarction (2,3,12,15,18), which aligns with our results. Selection bias is an obvious limitation of observational studies, resulting in unreliable results if improperly addressed.…”

“…The main outcome of this study was the incidence of postoperative self-care. According to the results of previous literature ( 12 ), GA (48%) and SA (31%), a minimum of 258 evaluable patients (129 per arm) would be required to detect a difference between the two groups at p = 0.05 (2-tailed), with a power of 90%. Thus, the sample size is enough for the current study.…”

Association of hemoglobin levels at admission with postoperative pneumonia in elderly patients with hip fracture: A retrospective cohort study

“…[35] However, several studies have found no relationship between different anesthetic techniques and POP in elderly patients undergoing hip fracture surgery. [36,37] This study also did not find any effect of anesthesia on POP. Therefore, future large prospective studies Our study indicates that elderly hip fracture patients with preoperative Hb levels < 83.5 g/L should be considered for blood transfusions to reduce the occurrence of POP.…”

“…[35] However, several studies have found no relationship between different anesthetic techniques and POP in elderly patients undergoing hip fracture surgery. [36,37] This study also did not find any effect of anesthesia on POP. Therefore, future large prospective studies are necessary to explore the effect of the anesthesia modality on POP in elderly patients with hip fractures.…”

The Incidence of Acute Respiratory Infection Was Higher in the Older Adults with Lower Limb Fracture Who Receive Spinal Anesthesia Than Those Who Receive General Anesthesia

“…Studies in the last five years have suggested that the incidence of pneumonia in patients who undergo GA for hip fracture surgery is similar to that in patients who undergo neuraxial anesthesia for this procedure [ 5 , 8 , 11 ]. Acute upper and lower respiratory infection may significantly reduce postoperative quality of life and impair the recovery of geriatric patients with lower-limb fractures [ 12 ]; however, the literature has mostly focused on the pulmonary complications after fracture surgery and few have mentioned the incidence of ARI during a short postoperative period, which may be related to the late respiratory complications and may need to be carefully prevented during the COVID-19 pandemic. This study aims to clarify how different anesthesia methods influence the incidence of ARI during the one-month postoperative period and to identify the related risk factors.…”