Perioperative outcomes and type of anesthesia in hip surgical patients: An evidence based review

Abstract

Over the last decades the demand for hip surgery, be it elective or in a traumatic setting, has greatly increased and is projected to expand even further. Concurrent with demographic changes the affected population is burdened by an increase in average comorbidity and serious complications. It has been suggested that the choice of anesthesia not only affects the surgery setting but also the perioperative outcome as a whole. Therefore different approaches and anesthetic techniques have been developed to offer individual anesthetic and analgesic care to hip surgery patients. Recent studies on comparative effectiveness utilizing population based data have given us a novel insight on anesthetic practice and outcome, showing favorable results in the usage of regional vs general anesthesia. In this review we aim to give an overview of anesthetic techniques in use for hip surgery and their impact on perioperative outcome. While there still remains a scarcity of data investigating perioperative outcomes and anesthesia, most studies concur on a positive outcome in overall mortality, thromboembolic events, blood loss and transfusion requirements when comparing regional to general anesthesia. Much of the currently available evidence suggests that a comprehensive medical approach with emphasis on regional anesthesia can prove beneficial to patients and the health care system.

Vitamin D serum levels are associated with handgrip strength but not with muscle mass or length of hospital stay after hip fracture

“…Although the incidence rate varies dramatically across continents, there are expectations that this number will continue to rise, mainly in developing countries [1][2][3][4]. The worldwide annual rate of hip fractures has been projected to increase from 1.66 million in 1990 to 6.26 million in the year 2050 [5,6]. Hip fractures have a great effect on patient independence, resulting in nursing home stays, increased mortality and lower quality of life [7,8].…”

A Longitudinal Supra-Inguinal Fascia Iliaca Compartment Block Reduces Morphine Consumption After Total Hip Arthroplasty

“…2 Regional anesthesia techniques reduce postoperative opioid consumption and pain scores leading to higher patient satisfaction and better outcomes. 3 The hip joint is innervated by branches of the femoral nerve (FN), obturator nerve (ON), and sciatic nerve (SN). The lateral femoral cutaneous nerve (LFCN) should also be blocked if the surgical incision extends to the lateral side of the thigh.…”

Goldman score, but not Detsky or Lee indices, predicts mortality 6 months after hip fracture

“…In fact, these patients often have multiple comorbidities, and frequent perioperative cardiac over screening [17]. As a result, there was a delay to surgery and the delay was associated with more cardiovascular complications and higher mortality [5, 6, 17]. …”

“…Importantly, the majority of hip fractures occur in the elderly patient population. Emerging evidence suggests that early surgery decreases mortality and minimizes complications secondary to immobilization [5, 6]. However, the perioperative evaluation for hip fracture patients can represent a major challenge, since these patients normally have multiple comorbidities [6, 7].…”