Prospective, multi-centre trial of mortality following general or spinal anaesthesia for hip fracture surgery in the elderly.
In a prospective randomized multi-centre study, the mortality following internal fixation surgery for fracture of the upper femur was investigated in 538 elderly patients allocated to receive subarachnoid blockade or general (narcotic-relaxant) anaesthesia. The 28-day mortality was 6.6% with subarachnoid, and 5.9% with general, anaesthesia. The difference was not significant (95% confidence limits: -3.5 to +4.8). At 1 year following surgery, the mortality was 20.4%. Increasing age, ischaemic heart disease, cardiac failure, preoperative arrhythmias and poor ASA status were all associated with increases in early and long term mortality. A delay to surgery of more than 24 h from admission was also associated with an increased 28-day mortality. Senile dementia and admission other than from the patient's own home, were factors associated with a poorer long term outcome. From the point of view of mortality, subarachnoid anaesthesia did not appear to confer any advantages over general anaesthesia in non-prosthetic surgery for hip fracture in the elderly.
Davis
F M
FM
Christchurch Clinical School, New Zealand.
Woolner
D F
DF
Frampton
C
C
Wilkinson
A
A
Grant
A
A
Harrison
R T
RT
Roberts
M T
MT
Thadaka
R
R
D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General / Q000401:mortality*; D000775:Anesthesia, Spinal / Q000401:mortality*; D002986:Clinical Trials as Topic; D004630:Emergencies; D005260:Female; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000401:mortality; D011446:Prospective Studies; D011897:Random Allocation