title: Prospective, multi-centre trial of mortality following general or spinal anaesthesia for hip fracture surgery in the elderly.
abstract: 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.
authors.affiliation: Christchurch Clinical School, New Zealand.
authors.forename: F M
authors.initials: FM
authors.lastname: Davis
authors.forename: D F
authors.initials: DF
authors.lastname: Woolner
authors.forename: C
authors.initials: C
authors.lastname: Frampton
authors.forename: A
authors.initials: A
authors.lastname: Wilkinson
authors.forename: A
authors.initials: A
authors.lastname: Grant
authors.forename: R T
authors.initials: RT
authors.lastname: Harrison
authors.forename: M T
authors.initials: MT
authors.lastname: Roberts
authors.forename: R
authors.initials: R
authors.lastname: Thadaka
mesh_terms: 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