title: Retrospective comparison of the effects of epidural anesthesia versus peripheral nerve block on postoperative outcomes in elderly Chinese patients with femoral neck fractures.
abstract: BACKGROUND
  Geriatric patients with femoral neck fracture (FNF) have unacceptably high rates of postoperative complications and mortality. The purpose of this study was to compare the effects of epidural anesthesia versus peripheral nerve block (PNB) on postoperative outcomes in elderly Chinese patients with FNF.
  
  
  METHODS
  This retrospective study explored mortality and postoperative complications in geriatric patients with FNF who underwent epidural anesthesia or PNB at the Chinese People's Liberation Army General Hospital from January 2008 to December 2012. The electronic database at the Chinese People's Liberation Army General Hospital includes discharge records for all patients treated in the hospital. Information on patient demographics, preoperative comorbidity, postoperative complications, type of anesthesia used, and in-hospital, 30-day, and 1-year mortality after surgery was obtained from this database.
  
  
  RESULTS
  Two hundred and fifty-eight patients were identified for analysis. The mean patient age was 79.7 years, and 71.7% of the patients were women. In-hospital, 30-day, and 1-year postoperative mortality was 4.3%, 12.4%, and 22.9%, respectively, and no differences in mortality or cardiovascular complications were found between patients who received epidural anesthesia and those who received PNB. More patients with dementia or delirium were given PNB. No statistically significant differences were found between groups for other comorbidities or intraoperative parameters. The most common complications were acute cardiovascular events (23.6%), electrolyte disturbances (20.9%), and hypoxemia (18.2%). Patients who received PNB had more postoperative delirium (P=0.027). Postoperative acute respiratory events were more common (P=0.048) and postoperative stroke was less common (P=0.018) in the PNB group. There were fewer admissions to intensive care (P=0.024) in the epidural anesthesia group. Key factors with a negative influence on mortality were acute cardiovascular events, dementia, male sex, age, American Society of Anesthesiologists score, acute respiratory events, intensive care admission, and comorbidities.
  
  
  CONCLUSIONS
  PNB was not associated with lower mortality or lower cardiovascular complication rates when compared with epidural anesthesia in elderly patients with FNF.
authors: Department of Clinical Medicine, Fujian Health College, Fuzhou, People's Republic of China.
authors: Jianwen
authors: J
authors: Jin
authors: Department of Anesthesiology, Chinese People's Liberation Army 105 Hospital, Hefei, People's Republic of China.
authors: Gang
authors: G
authors: Wang
authors: Anesthesia and Operation Center, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China.
authors: Maowei
authors: M
authors: Gong
authors: Anesthesia and Operation Center, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China.
authors: Hong
authors: H
authors: Zhang
authors: Department of Anesthesiology, Chinese People's Liberation Army 105 Hospital, Hefei, People's Republic of China.
authors: Junle
authors: J
authors: Liu
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000767:Anesthesia, Epidural / Q000009:adverse effects* / Q000379:methods*; D002318:Cardiovascular Diseases / Q000453:epidemiology; D002681:China / Q000453:epidemiology; D003704:Dementia / Q000453:epidemiology; D005260:Female; D005265:Femoral Neck Fractures / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D009407:Nerve Block / Q000009:adverse effects* / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors
keywords: elderly; epidural anesthesia; femoral neck fractures; peripheral nerve block; postoperative outcomes