Comparison of general anaesthesia and regional anaesthesia in terms of mortality and complications in elderly patients with hip fracture: a nationwide population-based study

Abstract

ObjectiveTo evaluate the effects of anaesthesia on postoperative outcome in elderly patients who underwent hip fracture surgery.SettingNationwide National Health Insurance Sharing Service database of Korea.ParticipantsAll patients aged ≥65 years old who underwent hip fracture surgery, covered by the Korean National Health Insurance, between 1 January 2009 and 31 December 2015.InterventionsHip fracture surgery under general anaesthesia (group GA) or regional anaesthesia (group RA), with a principal diagnosis of femoral fracture.Primary and secondary outcome measuresThe primary outcome was the anaesthetic-type effect on 30-day mortality and the secondary outcome was postoperative delirium requiring pharmacological intervention.ResultsAmong the 96 289 patients who underwent hip fracture surgery, 25 593 and 70 696 patients received GA and RA, respectively. After propensity score matching, 25 593 remained in each group. Postmatching mortality was lower in the RA than in the GA group (574 (2.24%) vs 654 (2.55%), p=0·0047, 95% CI −0.0099 to 0.0159). Delirium incidence was lower in the RA than in the GA group (5187 (20.27%) vs 5828 (22.77%), p<0·0001, 95% CI 0.019 to 0.045). The incidence of intensive care unit stay and ventilator care was lower in the RA than in the GA group (5838 (22.1%) vs 8055 (31.47%), p<0·0001, 95% CI 0.046 to 0.070 and 459 (1.73%) vs 1207 (4.72%), p<0·0001, 95% CI −0.0024 to 0.023, respectively).ConclusionRA was associated with better outcomes than GA, in terms of mortality, delirium, intensive care unit admission and ventilator care, in elderly patients who underwent hip fracture surgery.

Preoperative prognostic nutritional index predicts postoperative delirium in elderly patients after hip fracture surgery

“…29 The use of general anaesthesia and a longer surgical duration (>3 h) were considered as potential risk factors for POD after orthopaedic surgery by Tabet et al 30 A nationwide population-based study by Ahn et al has reported a close association between type of anaesthesia and postoperative complications including POD in elderly subjects with hip fracture. 31 Until now, the pathophysiology of POD has remained unclear and the crossroads of many mechanisms (neuroinflammation, surgical stress response, microglia activation, etc.) are involved in the development of POD.…”

Utilization of a Continuous Pericapsular Nerve Group (PENG) Block with an Opioid-Sparing Repair of a Femoral Neck Fracture in a Pediatric Patient

“…Inadequate analgesia can contribute to patient and parental dissatisfaction, prolonged recovery, and increased hospital length of stay. While there is a paucity of pediatric data, adult literature has described an association between the utilization of regional anesthesia and decreased postoperative delirium, hospital length of stay, intensive care admission, and overall mortality among geriatric patients undergoing hip replacement surgery [2]. As such, regional anesthesia is advantageous in providing sufficient analgesia while reducing the adverse effects of opioids.…”

Introducing big data analysis using data from National Health Insurance Service

“…Various studies have been conducted using data from the National Health Insurance Database, such as studies that analyzed socio-economic costs of specific diseases [2][3][4], studies that described prevalence, mortality, or causes of death [5][6][7][8], and studies that analyzed the causes of death according to socio-economic level and disease using the 10th percentile variable of health insurance premium income [9]. Other studies have analyzed mortality or morbidity ac-cording to specific medical practices (general anesthesia vs. regional anesthesia) [10,11].…”