Similar Survival for Anesthesia Options for Hip Fracture Surgery

Regional anesthesia for hip fracture surgery was not associated with increased 30 day mortality compared to general anesthesia

(RxWiki News) A hip fracture can mean surgery and a hospital stay. The type of anesthesia used in that surgery might affect the length of the hospital stay and recovery.

Recent surgical guidelines recommended the use of regional anesthesia to reduce complications after hip surgery. In regional anesthesia a large part of the body is anesthetized — such as in spinal or epidural anesthesia — but the patient is not unconscious, as is the case in general anesthesia.

Researchers compared the two types of surgical anesthesia in hip fracture patients and found that there was no difference in survival a month after surgery. Patients who had regional anesthesia had a slightly shorter hospital stay.

"Talk to your anesthesiologist about anesthesia options."

Mark D. Neuman, MD, MSc from the Department of Anesthesiology and Critical Care at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, PA, led this research team.

These researchers collected data on patients aged 50 and older who had hip fracture surgery in New York. The study included 56,729 patients, 28 percent of whom had regional anesthesia during surgery and 72 percent who had general anesthesia.

In addition to the type of anesthesia used, Dr. Neuman and his team noted whether the hospitals used by the patients specialized in regional or general anesthesia.

The researchers analyzed the association between regional anesthesia or general anesthesia and survival 30 days after surgery. They also compared type of the anesthesia with the length of hospital stay after hip fracture surgery.

Similar death rates were seen in the two anesthesia groups in the 30 days following surgery. In the patients who received regional anesthesia, 5.3 percent died. The 30-day death rate in the patients who received general anesthesia was 5.4 percent.

A slight decrease in hospital stay was seen in regional anesthesia patients compared to general anesthesia patients.

Patients who had regional anesthesia had an average hospital stay of six days, while those who had general anesthesia stayed an average of 6.3 days.

Patients who lived closer to hospitals specializing in either regional or general anesthesia were more apt to receive the type of anesthesia that was the hospital’s specialty. The anesthesia specialty of the hospital did not affect the 30 day survival rates of patients having hip surgery.

The authors noted some limitations to their study. The research was done in New York only. Also, the outcomes of some patients could not be assessed due to missing anesthesia data.

“Regional anesthesia is used as the primary anesthetic technique in a minority of hip fracture surgeries performed in the United States and in other countries, and increasing its use has been proposed as a strategy to improve the quality of hip fracture care,” the authors wrote.

“We found an association between greater use of regional anesthesia and a reduction in length of stay after hip fracture; however, we did not find regional anesthesia to be associated with statistically significant differences in mortality [death]," they wrote.

This study appeared online on June 24 in JAMA.

Funding for this research was provided by grants from the National Institute on Aging and from the National Science Foundation.

The authors disclosed no conflicts of interest.

Review Date: 
June 22, 2014