Comparative outcomes of peripheral nerve blocks versus general anesthesia for hip fractures in geriatric Chinese patients

Abstract

BackgroundGeriatric patients undergoing hemiarthroplasty for hip fractures have unacceptably high rates of postoperative complications and mortality. Whether anesthesia type can affect the outcomes has still been inconclusive.ObjectivesWe compared general anesthesia (GA) and peripheral nerve blocks (PNBs) on postoperative complications and mortality in elderly patients with femoral neck fractures (FNF) undergoing hemiarthroplasty.Materials and methodsThis retrospective study involved data collection from an electronic database. Two hundred and seventeen patients underwent hemiarthroplasty for FNF between January 2008 and December 2012 at the Chinese People’s Liberation Army General Hospital. Data on mortality within in-hospital, 30-day, and 1-year, complications, comorbidities, blood loss and transfusion, operative time, postoperative hospital length of stay, intensive care unit admission, and hospital charge were collected and analyzed. Univariate and multivariate Cox regression analyses of all variables were used for 30-day and 1-year mortality.ResultsSeventy-two patients receiving GA and 145 receiving PNBs were eventually submitted and analyzed. Mortality was 6.9%, 14.7%, and 23.5% at in-hospital, 30-day, and 1-year, respectively postoperatively, while mortality and cardiovascular complications did not differ between the two anesthetic techniques. Preoperative comorbidities and intraoperative parameters were not statistically different except that patients receiving GA were more likely to have dementia (χ2=10.45, P=0.001). The most common complications were acute cardiovascular events, electrolyte disturbances, and delirium. Postoperative acute respiratory events and hypoxemia both were also common, but no differences were found between groups (χ2=0.68, P=0.410; χ2=3.42, P=0.065, respectively). Key factors negatively influencing mortality included: age, male gender, American Society of Anesthesiologists status, dementia, perioperative cardiovascular events and respiratory events, postoperative stroke, myocardial infarction, and hypoxia.ConclusionMortality and postoperative complications are not statistically significantly different between PNBs and GA among eldery patients undergoing hemiarthroplasty for FNF.

Effect of regional versus general anaesthesia on postoperative delirium in elderly patients undergoing surgery for hip fracture: a systematic review

“…Four studies found a statistically significant difference in favour of RA (fewer cases of ventilatory support,68 respiratory failure20 68 and ‘overall pulmonary’ adverse events20 51). There were no differences in occurrences of pneumonia35 48 52 95 or hypoxia 75 101. The most commonly reported cardiovascular adverse events were myocardial infarction39 48 68 95 and thromboembolic events 35 58 69 81 95.…”

A systematic review and meta-analysis of anesthesia type on hip fracture post-surgery outcomes

“…Full texts were retrieved and reviewed for 53 articles. Ultimately, 28 studies met all inclusion criteria, [22–49] consisting of 11 prospective studies and 17 retrospective studies (Fig. 1).…”

“…of studies Odds ratio 95% Note: All comparisons are directionally general anesthesia versus spinal/regional anesthesia: values less than 1 have a lower relative odds of the event of interest in the GA group compared to the S/R group and values higher than 1 have a higher relative odds of the event of interest in the GA group compared to the S/R group; No of studies: number of studies with sufficient information to compare odds of event between general anesthesia and spinal/regional anesthesia. [21,24,25,30,31,35,38,40,42,44,45] ----Retrospective [20,22,23,[26][27][28][29][32][33][34]36,37,39,41,43,46,47] À0 Other reports indicate that factors such as age, comorbidities, and procedural characteristics may have substantial influence on 30-day mortality. It has been shown that in the first 3 months after hip fractures, the risk of mortality in adults over 50 years of age is 5-to 8-times greater than for those under 50.…”

Effect of the Anesthesia Method on Mortality and Postoperative Complications in ASA III-IV Graded Geriatric Patients

“…Çeşitli çalışmalar ASA skorunun geriatrik hastalarda mortaliteyi etkileyebileceğini belirtmişlerdir. ASA III-IV gibi yüksek ASA skoru olan geriatrik hastalarda mortalite daha yüksek oranda görülmektedir (9,10) . Biz de çalışmamızda yalnızca yüksek risk grubu hastaları değerlendirmek amacıyla ASA III ve IV hastalar üzerinde çalışma yapmayı tercih ettik.…”