Sedation depth during spinal anesthesia and survival in elderly patients undergoing hip fracture repair.
Low intraoperative Bispectral Index (BIS) values may be associated with increased mortality. In a previously reported trial to prevent delirium, we randomized patients undergoing hip fracture repair under spinal anesthesia to light (BIS >80) or deep (BIS approximately 50) sedation. We analyzed survival of patients in the original trial. Among all patients, mortality was equivalent across sedation groups. However, among patients with serious comorbidities (Charlson score >4), 1-year mortality was reduced in the light (22.2%) vs deep (43.6%) sedation group (hazard ratio [HR], 0.43; 95% confidence interval, 0.19-0.97; P = 0.04) during spinal anesthesia. Similarly, among patients with Charlson score >6, 1-year mortality was reduced in the light (28.6%) vs deep (52.6%) sedation group (HR 0.33; 95% confidence interval, 0.12-0.94; P = 0.04) during spinal anesthesia. Further research on reduced mortality after light sedation during spinal anesthesia is needed.
From the *Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medical Institutions; and †Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Charles H
CH
Brown
Andrew S
AS
Azman
Allan
A
Gottschalk
Simon C
SC
Mears
Frederick E
FE
Sieber
D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General; D000775:Anesthesia, Spinal / Q000379:methods*; D016292:Procedural Sedation / Q000379:methods*; D054810:Deep Sedation / Q000379:methods*; D003693:Delirium / Q000453:epidemiology / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000523:psychology; D016019:Survival Analysis; D016896:Treatment Outcome