Short-term complications in hip fracture surgery using spinal versus general anaesthesia

Fields, Adam C.; Dieterich, James D.; Buterbaugh, Kristin; Moucha, Calin S.

doi:10.1016/j.injury.2015.02.002

Cited by 82 publications

(75 citation statements)

References 28 publications

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“…This study has several strengths in comparison to previous observational studies : it was conducted prospectively; it captured data about large numbers of patients (~ one‐fifth of all hip fractures in England, Wales and Northern Ireland annually); and data‐point completion rates were high (> 90% for most fields). Importantly, data about anaesthesia were collected by anaesthetists and so are likely to provide a far more accurate indication of actual interventions than retrospective data about anaesthesia collected by non‐anaesthetists .…”

Section: Discussionmentioning

confidence: 99%

Secondary analysis of outcomes after 11,085 hip fracture operations from the prospective UK Anaesthesia Sprint Audit of Practice (ASAP-2)

et al. 2016

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SummaryWe re-analysed prospective data collected by anaesthetists in the Anaesthesia Sprint Audit of Practice (ASAP-1) to describe associations with linked outcome data. Mortality was 165/11,085 (1.5%) 5 days and 563/11,085 (5.1%) 30 days after surgery and was not associated with anaesthetic technique (general vs. spinal, with or without peripheral nerve blockade). The risk of death increased as blood pressure fell: the odds ratio (95% CI) for mortality within five days after surgery was 0.983 (0.973-0.994) for each 5 mmHg intra-operative increment in systolic blood pressure, p = 0.0016, and 0.980 (0.967-0.993) for each mmHg increment in mean pressure, p = 0.0039. The equivalent odds ratios (95% CI) for 30-day mortality were 0.968 (0.951-0.985), p = 0.0003 and 0.976 (0.964-0.988), p = 0.0001, respectively. The lowest systolic blood pressure after intrathecal local anaesthetic relative to before induction was weakly correlated with a higher volume of subarachnoid bupivacaine: r 2 À0.10 and À0.16 for hyperbaric and isobaric bupivacaine, respectively. A mean 20% relative fall in systolic blood pressure correlated with an administered volume of 1.44 ml hyperbaric bupivacaine. Future research should focus on refining standardised anaesthesia towards administering lower doses of spinal (and general) anaesthesia and maintaining normotension.

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Section: Discussionmentioning

confidence: 99%

Secondary analysis of outcomes after 11,085 hip fracture operations from the prospective UK Anaesthesia Sprint Audit of Practice (ASAP-2)

et al. 2016

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“…In this study, the number of patients that underwent general anesthesia was high (65%). Whether general or spinal anesthesia leads to fewer complications in hip fracture patients is still a matter of debate [24–27]. The recent Cochrane review did not find a difference in either technique and asked for more research [28].…”

Section: Discussionmentioning

confidence: 99%

Complications after hip fracture surgery: are they preventable?

Flikweert

Wendt

Diercks

et al. 2017

Eur J Trauma Emerg Surg

107

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PurposeSurgery for hip fractures is frequently followed by complications that hinder the rehabilitation of patients. The aim of this study was to describe the incidence rate and type of complications, including mortality, after hip fracture surgery, and to identify the risk factors of these complications that may be amenable to prevention.MethodsProspective cohort study of all consecutive patients aged ≥60 treated for a hip fracture at University Medical Center Groningen between July 2009 and June 2013. All patients were treated in a comprehensive multidisciplinary care pathway. Logistic regression analyses were used to investigate which variables were significant risk factors for the occurrence of complications. Additional analyses were conducted to investigate whether the independent variables were significant risk factors for several specific complications and mortality.ResultsThe study population consisted of 479 patients with a mean age of 78.4 (SD 9.5) years; 33% were men. The overall complication rate was 75%. Delirium was the complication seen most frequently (19%); the incidence of surgical complications was 9%. Most risk factors for complications were not preventable (high comorbidity rate, high age and dependent living situation). However, general anesthesia (OR 1.51; 95% CI 0.97–2.35) and delay in surgery (OR 3.16; 95% CI 1.43–6.97) may be risk factors that can potentially be prevented. Overall, the mortality risk was not higher in patients with a complication, but delirium and pneumonia were risk factors for mortality.ConclusionThe overall complication rate after hip fracture surgery was high. Only few complications were potentially preventable.

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“…10 Sjúklingar sem gangast undir aðgerð vegna mjaðm-arbrots fá annaðhvort maenudeyfingu eða eru svaefðir. Í nýlegum rannsóknum hefur ekki fundist munur á dánartíðni milli maenudeyfingar og svaefingar 18,19 en aðgerðar-og legutími er styttri ef maenudeyfing er notuð. 18 Einnig hefur verið sýnt fram á minni líkur á blóðsegamyndun í djúpum bláaeðum og faerri blóðgjafir við maenudeyfingu.…”

Section: áGripunclassified

“…18 Einnig hefur verið sýnt fram á minni líkur á blóðsegamyndun í djúpum bláaeðum og faerri blóðgjafir við maenudeyfingu. 19 Meðallegutími eftir mjaðmarbrot er misjafn eftir löndum en hann er á bilinu 9-12 dagar í Bretlandi og Danmörku 5,20 en einungis 5-6 dagar í Bandaríkjunum. 21 Skipulag heilbrigðiskerfis hefur að sjálfsögðu mikil áhrif á þennan þátt, til daemis aðgengi að heimahjúkrun, sjúkra-hótelum, hjúkrunarheimilum og endurhaefingu eftir aðgerð.…”

Section: áGripunclassified

“…Maenudeyfing virðist þó hafa vissa kosti fram yfir svaefingu í mjaðmarbrotum, með laegri tíðni fylgikvilla og styttri aðgerðar-og legutíma. 18,19,31 Meðallegutími á baeklunarskurðdeild var 11 dagar sem er sambaerilegt við 9-12 daga í Bretlandi og Danmörku 5,20 en töluvert lengri en í Bandaríkjunum 21 þar sem hann var 5-6 dagar. Marktaekur munur var á legutíma sjúklinga sem búa á eigin heimili og hjúkrunarheimili fyrir brot, eða 14 og fjórir dagar hvor um sig (p=0,001).…”

Section: Umraeðaunclassified

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