Hip Fracture Mortality: is It Affected by Anesthesia Techniques?

Overview

Journal Anesthesiol Res Pract

Publisher Wiley

Specialty Anesthesiology

Date 2012 Feb 1

PMID 22291699

Citations 21

Authors

Saffet Karaca

Egemen Ayhan

Hayrettin Kesmezacar

Omer Uysal

Affiliations

Soon will be listed here.

Abstract

We hypothesized that combined peripheral nerve block (CPNB) technique might reduce mortality in hip fracture patients with the advantage of preserved cardiovascular stability. We retrospectively analyzed 257 hip fracture patients for mortality rates and affecting factors according to general anesthesia (GA), neuraxial block (NB), and CPNB techniques. Patients' gender, age at admission, trauma date, ASA status, delay in surgery, followup period, and Barthel Activities of Daily Living Index were determined. There were no differences between three anesthesia groups regarding to sex, followup, delay in surgery, and Barthel score. NB patients was significantly younger and CPNB patients' ASA status were significantly worse than other groups. Mortality was lower for regional group (NB + CPNB) than GA group. Mortality was increased with age, delay in surgery, and ASA and decreased with CPNB choice; however, it was not correlated with NB choice. Since the patients' age and ASA status cannot be changed, they must be operated immediately. We recommend CPNB technique in high-risk patients to operate them earlier.

Citing Articles

Efficacy of the inferior vena cava collapsibility index in predicting anaesthesia-induced hypotension in elderly patients undergoing hip arthroplasty.

Liu Y, Zhang Y, Wang A, Xu X, Ding Q, Xu Y Sci Rep. 2024; 14(1):27156.

PMID: 39511386 PMC: 11543812. DOI: 10.1038/s41598-024-78718-3.

The addition of peripheral nerve blocks to routine spinal or general anesthesia was associated with decreased risks of major adverse events after total hip or knee arthroplasty: A retrospective, propensity score-matched cohort study.

Chen Y, Lin J, Chen X, Gong C, Xue F, Huang Y Heliyon. 2024; 10(12):e32441.

PMID: 39183870 PMC: 11341287. DOI: 10.1016/j.heliyon.2024.e32441.

Comparing perioperative outcomes between regional anesthesia and general anesthesia in patients undergoing hip fracture surgery: a systematic review and meta-analysis.

Liu S, Chen J, Shi H, Li J, Zeng G, Liu W Can J Anaesth. 2024; 71(6):849-869.

PMID: 38418761 DOI: 10.1007/s12630-024-02696-3.

Total intravenous anesthesia for geriatric hip fracture with severe systemic disease.

Huang Y, Hui C, Lau N, Ng Y, Lin T, Chen C Eur J Trauma Emerg Surg. 2023; 49(5):2139-2145.

PMID: 37354341 PMC: 10520204. DOI: 10.1007/s00068-023-02291-z.

Clinical Score for Predicting the Risk of Poor Ambulation at Discharge in Fragility Femoral Neck Fracture Patients: A Development Study.

Tangchitphisut P, Khorana J, Patumanond J, Rojanasthien S, Apivatthakakul T, Phinyo P J Clin Med. 2022; 11(16).

PMID: 36013106 PMC: 9410020. DOI: 10.3390/jcm11164871.

References

Asao Y, Higuchi T, Tsubaki N, Shimoda Y . [Combined paravertebral lumbar plexus and parasacral sciatic nerve block for reduction of hip fracture in four patients with severe heart failure]. Masui. 2005; 54(6):648-52. View

Keene G, Parker M, Pryor G . Mortality and morbidity after hip fractures. BMJ. 1993; 307(6914):1248-50. PMC: 1679389. DOI: 10.1136/bmj.307.6914.1248. View

Kesmezacar H, Ayhan E, Unlu M, Seker A, Karaca S . Predictors of mortality in elderly patients with an intertrochanteric or a femoral neck fracture. J Trauma. 2009; 68(1):153-8. DOI: 10.1097/TA.0b013e31819adc50. View

Haljamae H . Anesthetic risk factors. Acta Chir Scand Suppl. 1989; 550:11-9; discussion 19-21. View

Chia N, Low T, Poon K . Peripheral nerve blocks for lower limb surgery--a choice anaesthetic technique for patients with a recent myocardial infarction?. Singapore Med J. 2003; 43(11):583-6. View

Hamlet W, Lieberman J, Freedman E, Dorey F, Fletcher A, Johnson E . Influence of health status and the timing of surgery on mortality in hip fracture patients. Am J Orthop (Belle Mead NJ). 1997; 26(9):621-7. View

Sexson S, Lehner J . Factors affecting hip fracture mortality. J Orthop Trauma. 1987; 1(4):298-305. DOI: 10.1097/00005131-198701040-00005. View

Rodgers A, Walker N, Schug S, McKee A, Kehlet H, van Zundert A . Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ. 2000; 321(7275):1493. PMC: 27550. DOI: 10.1136/bmj.321.7275.1493. View

Sircar P, Godkar D, Mahgerefteh S, Chambers K, Niranjan S, Cucco R . Morbidity and mortality among patients with hip fractures surgically repaired within and after 48 hours. Am J Ther. 2007; 14(6):508-13. DOI: 10.1097/01.pap.0000249906.08602.a6. View

10.

Ho A, Karmakar M . Combined paravertebral lumbar plexus and parasacral sciatic nerve block for reduction of hip fracture in a patient with severe aortic stenosis. Can J Anaesth. 2002; 49(9):946-50. DOI: 10.1007/BF03016880. View

11.

Schroder H, Erlandsen M . Age and sex as determinants of mortality after hip fracture: 3,895 patients followed for 2.5-18.5 years. J Orthop Trauma. 1993; 7(6):525-31. DOI: 10.1097/00005131-199312000-00007. View

12.

Dzupa V, Bartonicek J, Skala-Rosenbaum J, Prikazsky V . [Mortality in patients with proximal femoral fractures during the first year after the injury]. Acta Chir Orthop Traumatol Cech. 2002; 69(1):39-44. View

13.

Vestergaard P, Rejnmark L, Mosekilde L . Has mortality after a hip fracture increased?. J Am Geriatr Soc. 2007; 55(11):1720-6. DOI: 10.1111/j.1532-5415.2007.01420.x. View

14.

Michel J, Klopfenstein C, Hoffmeyer P, Stern R, Grab B . Hip fracture surgery: is the pre-operative American Society of Anesthesiologists (ASA) score a predictor of functional outcome?. Aging Clin Exp Res. 2003; 14(5):389-94. DOI: 10.1007/BF03324467. View

15.

de Visme V, Picart F, Le Jouan R, Legrand A, Savry C, Morin V . Combined lumbar and sacral plexus block compared with plain bupivacaine spinal anesthesia for hip fractures in the elderly. Reg Anesth Pain Med. 2000; 25(2):158-62. DOI: 10.1053/rapm.2000.0250158. View

16.

Aharonoff G, Koval K, Skovron M, Zuckerman J . Hip fractures in the elderly: predictors of one year mortality. J Orthop Trauma. 1997; 11(3):162-5. DOI: 10.1097/00005131-199704000-00004. View

17.

Farahmand B, Michaelsson K, Ahlbom A, Ljunghall S, Baron J . Survival after hip fracture. Osteoporos Int. 2005; 16(12):1583-90. DOI: 10.1007/s00198-005-2024-z. View

18.

Parker M, Handoll H, Griffiths R . Anaesthesia for hip fracture surgery in adults. Cochrane Database Syst Rev. 2004; (4):CD000521. DOI: 10.1002/14651858.CD000521.pub2. View

19.

Karagiannis A, Papakitsou E, Dretakis K, Galanos A, Megas P, Lambiris E . Mortality rates of patients with a hip fracture in a southwestern district of Greece: ten-year follow-up with reference to the type of fracture. Calcif Tissue Int. 2006; 78(2):72-7. DOI: 10.1007/s00223-005-0169-6. View

20.

Cipitria J, Sosa M, Pezzotto S, Puche R, Bocanera R . Outcome of hip fractures among elderly subjects. Medicina (B Aires). 1997; 57(5):530-4. View