Long-Term Outcome After Repair of Fractured Neck of Femur

Abstract

One hundred and forty-eight patients undergoing "pin-and-plate" repair of fractured neck of femur received either subarachnoid blockade or general anaesthesia. The patients were followed up for 1 year after surgery. At the end of the year, 34% had died and 50% had returned home. Twelve per cent were either in hospital or in institutional care; 4% were lost to follow up. The mean duration of acute plus convalescent hospital bed occupancy was 84.4 days. There was a significantly lower mortality in the subarachnoid anaesthetic group by 14 days after surgery. The majority of the deaths in the general anaesthetic group were clustered between 6 and 16 days. However, at the end of 2 months the mortality rates were similar in both groups. It is conceivable that the difference in the distribution of deaths between the groups was a result of thrombo-embolism.

Acute Confusional States in Elderly Patients Treated for Femoral Neck Fracture

“…There are contradictory results from studies comparing the incidence of ACS with different anesthetic techniques in elderly patients undergoing hip surgery 19–25 . There are also differing opinions about the importance of the type or length of surgery upon the outcome for the patient 26–29 …”

Anaesthesia for hip surgery in the elderly

“…Some investigators have used small incremental doses of fentanyl 3t or ketamine 32 to facilitate positioning, while others have performed blocks without supplemental analgesia. 34 Technical failure in performing spinal anaesthesia for hip fracture surgery occurs in approximately ten per cent of cases. 10,31 Intraoperative blood pressure stability is a problem, regardless of anaesthetic technique.…”

Anaesthesia and Outcome of Surgery for Fractured Neck of Femur

“…Whilst some of these data may not have been available at the time when the study of Coleman and colleagues was planned, even taking the older mortality figures quoted (32% for controlled ventilation [4] and 18% for spontaneous ventilation general anaesthesia [5], a study of 152 patients has insufficient power (p approximately = 0.60 at a = 0.05) to detect a difference of this magnitude. To give this study sufficient power ((3 ^ 0.80 at a = 0.05) to detect a significant difference between 0.32 and 0.18, the experiment would have required approximately 130 subjects per treatment group [6].…”