title: Regional anaesthesia for hip fracture surgery is associated with significantly more peri-operative complications compared with general anaesthesia.
abstract: BACKGROUND
  Although several studies have advocated the use of regional versus general anaesthesia as a means of reducing peri-operative complications from hip fracture surgery, the ideal method of anaesthesia remains controversial. Our purpose was to investigate the association between anaesthesia type and peri-operative complications in hip fracture surgery.
  
  
  METHODS
  From the 2005-2011 ACS-NSQIP database, all patients with operatively treated hip fractures were identified using CPT codes, and fifteen peri-operative complications were recorded and categorized as either minor or major. Rates of minor, major, and total complications by anaesthesia type were compared using chi-square and Fischer's exact tests. A multivariate model was used to determine odds of minor, major, and total complications between anaesthesia types. Multivariate analysis was then repeated after combining patients who received regional nerve blocks or spinal anaesthesia.
  
  
  RESULTS
  A total of 7,764 hip fracture patients were included in our analysis. Spinal anaesthesia had the highest total complication rate (19.6%), followed by general (17.9%) and regional nerve blocks (12.6%). Multivariate analysis demonstrated that spinal anaesthesia was associated with significantly greater odds of minor complications and total complications compared with general anaesthesia. After combining the regional nerve block and spinal anaesthesia groups, multivariate analysis again showed significantly greater odds of minor and total complications with regional versus general anaesthesia.
  
  
  CONCLUSIONS
  Using a large multi-centre database, we demonstrate that regional anaesthesia was associated with significantly greater odds of minor and total peri-operative complications compared with general anaesthesia. Our results challenge the notion that regional anaesthesia is the preferred method of anaesthesia for hip fractures in the elderly.
authors: The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue South, Suite 4200, Medical Center East, South Tower, Nashville, TN, 37232, USA, PSW.HMS@gmail.com.
authors: Paul S
authors: PS
authors: Whiting
authors: Cesar S
authors: CS
authors: Molina
authors: Sarah E
authors: SE
authors: Greenberg
authors: Rachel V
authors: RV
authors: Thakore
authors: William T
authors: WT
authors: Obremskey
authors: Manish K
authors: MK
authors: Sethi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D005260:Female; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009407:Nerve Block / Q000009:adverse effects*; D059035:Perioperative Period; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies