title: Short-term complications in hip fracture surgery using spinal versus general anaesthesia.
abstract: BACKGROUND
  Spinal anaesthesia when compared to general anaesthesia has been shown to decrease postoperative morbidity in orthopaedic surgery. The aim of the present study was to assess the differences in thirty-day morbidity and mortality for patients undergoing hip fracture surgery with spinal versus general anaesthesia.
  
  
  METHODS
  The American College of Surgeons National Surgical Quality and Improvement Program (NSQIP) database was used to identify patients who underwent hip fracture surgery with general or spinal anaesthesia between 2010 and 2012 using CPT codes 27245 and 27244. Patient characteristics, complications, and mortality rates were compared. Univariate analysis and multivariate logistic regression were used to identify predictors of thirty-day complications. Stratified propensity scores were employed to adjust for potential selection bias between cohorts.
  
  
  RESULTS
  6133 patients underwent hip fracture surgery with spinal or general anaesthesia; 4318 (72.6%) patients underwent fracture repair with general anaesthesia and 1815 (27.4%) underwent fracture repair with spinal anaesthesia. The spinal anaesthesia group had a lower unadjusted frequency of blood transfusions (39.34% versus 45.49%; p<0.0001), deep vein thrombosis (0.72% versus 1.64%; p=0.004), urinary tract infection (8.87% versus 5.76%; p<0.0001), and overall complications (45.75% versus 48.97%; p=0.001). The length of surgery was shorter in the spinal anaesthesia group (55.81 versus 65.36 min; p<0.0001). After multivariate logistic regression was used to adjust for confounders, general anaesthesia (odds ratio, 1.29; 95% confidence interval, 1.14-1.47; p=0.0002) was significantly associated with increased risk for complication after hip fracture surgery. Age, female sex, body mass index, hypertension, transfusion, emergency procedure, operation time, and ASA score were risk factors for complications after hip fracture repair (all p<0.05).
  
  
  CONCLUSIONS
  Patients who underwent hip fracture surgery with general anaesthesia had a higher risk of thirty-day complications as compared to patients who underwent hip fracture repair with spinal anaesthesia. Surgeons should consider using spinal anaesthesia for hip fracture surgery.
authors.affiliation: Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, United States.
authors.forename: Adam C
authors.initials: AC
authors.lastname: Fields
authors.affiliation: Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, United States.
authors.forename: James D
authors.initials: JD
authors.lastname: Dieterich
authors.affiliation: Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, United States.
authors.forename: Kristin
authors.initials: K
authors.lastname: Buterbaugh
authors.affiliation: Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, United States. Electronic address: calin.moucha@mountsinai.org.
authors.forename: Calin S
authors.initials: CS
authors.lastname: Moucha
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General; D000775:Anesthesia, Spinal; D005260:Female; D006620:Hip Fractures / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D061646:Operative Time; D019637:Orthopedic Procedures; D011183:Postoperative Complications / Q000453:epidemiology*; D058996:Quality Improvement; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Anaesthesia; Complications; General anaesthesia; Hip fracture; Local anaesthesia