General versus spinal anaesthesia for patients aged 70 years and older with a fracture of the hip.
The aim of this study was to compare the operating time, length of stay (LOS), adverse events and rate of re-admission for elderly patients with a fracture of the hip treated using either general or spinal anaesthesia. Patients aged ≥ 70 years who underwent surgery for a fracture of the hip between 2010 and 2012 were identified from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Of the 9842 patients who met the inclusion criteria, 7253 (73.7%) were treated with general anaesthesia and 2589 (26.3%) with spinal anaesthesia. On propensity-adjusted multivariate analysis, general anaesthesia was associated with slightly increased operating time (+5 minutes, 95% confidence interval (CI) +4 to +6, p < 0.001) and post-operative time in the operating room (+5 minutes, 95% CI +2 to +8, p < 0.001) compared with spinal anaesthesia. General anaesthesia was associated with a shorter LOS (hazard ratio (HR) 1.28, 95% CI 1.22 to 1.34, p < 0.001). Any adverse event (odds ratio (OR) 1.21, 95% CI 1.10 to 1.32, p < 0.001), thromboembolic events (OR 1.90, 95% CI 1.24 to 2.89, p = 0.003), any minor adverse event (OR 1.19, 95% CI 1.09 to 1.32, p < 0.001), and blood transfusion (OR 1.34, 95% CI 1.22 to 1.49, p < 0.001) were associated with general anaesthesia. General anaesthesia was associated with decreased rates of urinary tract infection (OR 0.73, 95% CI 0.62 to 0.87, p < 0.001). There was no clear overall advantage of one type of anaesthesia over the other, and surgeons should be aware of the specific risks and benefits associated with each type.
Yale School of Medicine, Department of Orthopaedics and Rehabilitation, 800 Howard Avenue, New Haven, CT, 06510, USA.
B A
BA
Basques
Yale School of Medicine, Department of Orthopaedics and Rehabilitation, 800 Howard Avenue, New Haven, CT, 06510, USA.
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Bohl
Yale School of Medicine, Department of Orthopaedics and Rehabilitation, 800 Howard Avenue, New Haven, CT, 06510, USA.
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Golinvaux
Yale School of Medicine, Department of Orthopaedics and Rehabilitation, 800 Howard Avenue, New Haven, CT, 06510, USA.
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Samuel
Yale School of Medicine , Department of Orthopaedics and Rehabilitation, 800 Howard Avenue, New Haven, CT, 06510, USA.
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Grauer
D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General; D000775:Anesthesia, Spinal; D015331:Cohort Studies; D005260:Female; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D015999:Multivariate Analysis; D061646:Operative Time; D010359:Patient Readmission; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies
anaesthesia; database; hip fracture; national surgery quality improvement program; trauma