title: Regional anesthesia as compared with general anesthesia for surgery in geriatric patients with hip fracture: does it decrease morbidity, mortality, and health care costs? Results of a single-centered study.
abstract: BACKGROUND
  Hip fracture in geriatric patients has a substantial economic impact and represents a major cause of morbidity and mortality in this population. At our institution, a regional anesthesia program was instituted for patients undergoing surgery for hip fracture. This retrospective cohort review examines the effects of regional anesthesia (from mainly after July 2007) vs general anesthesia (mainly prior to July 2007) on morbidity, mortality and hospitalization costs.
  
  
  METHODS
  This retrospective cohort study involved data collection from electronic and paper charts of 308 patients who underwent surgery for hip fracture from September 2006 to December 2008. Data on postoperative morbidity, in-patient mortality, and cost of hospitalization (as estimated from data on hospital charges) were collected and analyzed. Seventy-three patients received regional anesthesia and 235 patients received general anesthesia. During July 2007, approximately halfway through the study period, a regional anesthesia and analgesia program was introduced.
  
  
  RESULTS
  The average cost of hospitalization in patients who received surgery for hip fracture was no different between patients who receive regional or general anesthesia ($16,789 + 631 vs $16,815 + 643, respectively, P = 0.9557). Delay in surgery and intensive care unit (ICU) admission resulted in significantly higher hospitalization costs. Age, male gender, African American race and ICU admission were associated with increased in-hospital mortality. In-hospital mortality and rates of readmission are not statistically different between the two anesthesia groups.
  
  
  CONCLUSIONS
  There is no difference in postoperative morbidity, rates of rehospitalization, in-patient mortality or hospitalization costs in geriatric patients undergoing regional or general anesthesia for repair of hip fracture. Delay in surgery beyond 3 days and ICU admission both increase cost of hospitalization.
authors: Department of Anesthesiology Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA.
authors: Linda
authors: L
authors: Le-Wendling
authors: Azra
authors: A
authors: Bihorac
authors: Tezcan Ozrazgat
authors: TO
authors: Baslanti
authors: Stephen
authors: S
authors: Lucas
authors: Kalia
authors: K
authors: Sadasivan
authors: Adam
authors: A
authors: Wendling
authors: H James
authors: HJ
authors: Heyman
authors: Andre
authors: A
authors: Boezaart
mesh_terms: D000368:Aged; D000765:Anesthesia, Conduction / Q000191:economics* / Q000706:statistics & numerical data; D000768:Anesthesia, General / Q000191:economics*; D019644:Arthroplasty, Replacement, Hip / Q000191:economics* / Q000401:mortality*; D005260:Female; D005431:Florida / Q000453:epidemiology; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006620:Hip Fractures / Q000191:economics / Q000401:mortality / Q000601:surgery; D006801:Humans; D008297:Male; D015995:Prevalence; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome