title: Anesthesia technique, mortality, and length of stay after hip fracture surgery.
abstract: OBJECTIVE
  More than 300,000 hip fractures occur each year in the United States. Recent practice guidelines have advocated greater use of regional anesthesia for hip fracture surgery.
  
  
  OBJECTIVE
  To test the association of regional (ie, spinal or epidural) anesthesia vs general anesthesia with 30-day mortality and hospital length of stay after hip fracture.
  
  
  METHODS
  We conducted a matched retrospective cohort study involving patients 50 years or older who were undergoing surgery for hip fracture at general acute care hospitals in New York State between July 1, 2004, and December 31, 2011. Our main analysis was a near-far instrumental variable match that paired patients who lived at different distances from hospitals that specialized in regional or general anesthesia. Supplementary analyses included a within-hospital match that paired patients within the same hospital and an across-hospital match that paired patients at different hospitals.
  
  
  METHODS
  Spinal or epidural anesthesia; general anesthesia.
  
  
  METHODS
  Thirty-day mortality and hospital length of stay. Because the distribution of length of stay had long tails, we characterized this outcome using the Huber M estimate with Huber weights, a robust estimator similar to a trimmed mean.
  
  
  RESULTS
  Of 56,729 patients, 15,904 (28%) received regional anesthesia and 40,825 (72%) received general anesthesia. Overall, 3032 patients (5.3%) died. The M estimate of the length of stay was 6.2 days (95% CI, 6.2 to 6.2). The near-far matched analysis showed no significant difference in 30-day mortality by anesthesia type among the 21,514 patients included in this match: 583 of 10,757 matched patients (5.4%) who lived near a regional anesthesia-specialized hospital died vs 629 of 10,757 matched patients (5.8%) who lived near a general anesthesia-specialized hospital (instrumental variable estimate of risk difference, -1.1%; 95% CI, -2.8 to 0.5; P = .20). Supplementary analyses of within and across hospital patient matches yielded mortality findings to be similar to the main analysis. In the near-far match, regional anesthesia was associated with a 0.6-day shorter length of stay than general anesthesia (95% CI, -0.8 to -0.4, P < .001). Supplementary analyses also showed regional anesthesia to be associated with shorter length of stay, although the observed association was smaller in magnitude than in the main analysis.
  
  
  CONCLUSIONS
  Among adults in acute care hospitals in New York State undergoing hip repair, the use of regional anesthesia compared with general anesthesia was not associated with lower 30-day mortality but was associated with a modestly shorter length of stay. These findings do not support a mortality benefit for regional anesthesia in this setting.
authors: Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia2Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania.
authors: Mark D
authors: MD
authors: Neuman
authors: Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania3Department of Statistics, the Wharton School, University of Pennsylvania, Philadelphia.
authors: Paul R
authors: PR
authors: Rosenbaum
authors: Center for Outcomes Research, The Children's Hospital of Philadelphia.
authors: Justin M
authors: JM
authors: Ludwig
authors: Division of Decisions, Risk and Operations, Columbia Business School, New York, New York6Department of Statistics, Columbia University, New York, New York.
authors: Jose R
authors: JR
authors: Zubizarreta
authors: Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia2Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania4Center for Outcomes Research, The Children's Hospital of Ph.
authors: Jeffrey H
authors: JH
authors: Silber
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000767:Anesthesia, Epidural; D000768:Anesthesia, General; D000775:Anesthesia, Spinal; D015331:Cohort Studies; D005260:Female; D006620:Hip Fractures / Q000401:mortality* / Q000601:surgery*; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D008297:Male; D009518:New York; D012189:Retrospective Studies; D016896:Treatment Outcome