title: Secondary analysis of outcomes after 11,085 hip fracture operations from the prospective UK Anaesthesia Sprint Audit of Practice (ASAP-2).
abstract: We re-analysed prospective data collected by anaesthetists in the Anaesthesia Sprint Audit of Practice (ASAP-1) to describe associations with linked outcome data. Mortality was 165/11,085 (1.5%) 5 days and 563/11,085 (5.1%) 30 days after surgery and was not associated with anaesthetic technique (general vs. spinal, with or without peripheral nerve blockade). The risk of death increased as blood pressure fell: the odds ratio (95% CI) for mortality within five days after surgery was 0.983 (0.973-0.994) for each 5 mmHg intra-operative increment in systolic blood pressure, p = 0.0016, and 0.980 (0.967-0.993) for each mmHg increment in mean pressure, p = 0.0039. The equivalent odds ratios (95% CI) for 30-day mortality were 0.968 (0.951-0.985), p = 0.0003 and 0.976 (0.964-0.988), p = 0.0001, respectively. The lowest systolic blood pressure after intrathecal local anaesthetic relative to before induction was weakly correlated with a higher volume of subarachnoid bupivacaine: r(2) -0.10 and -0.16 for hyperbaric and isobaric bupivacaine, respectively. A mean 20% relative fall in systolic blood pressure correlated with an administered volume of 1.44 ml hyperbaric bupivacaine. Future research should focus on refining standardised anaesthesia towards administering lower doses of spinal (and general) anaesthesia and maintaining normotension.
authors.affiliation: Brighton and Sussex University Hospitals NHS Trust, Brighton, East Sussex, UK.
authors.forename: S M
authors.initials: SM
authors.lastname: White
authors.affiliation: Anaesthesia and Critical Care Section, Division of Clinical Neuroscience, University of Nottingham, Queen's Medical Centre Campus, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: I K
authors.initials: IK
authors.lastname: Moppett
authors.affiliation: Peterborough and Stamford Hospitals NHS Trust, Peterborough, UK.
authors.forename: R
authors.initials: R
authors.lastname: Griffiths
authors.affiliation: National Hip Fracture Database, Falls and Fragility Fracture Audit Programme, Clinical Effectiveness and Evaluation Unit, Royal College of Physicians, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Johansen
authors.affiliation: National Hip Fracture Database, Falls and Fragility Fracture Audit Programme, Clinical Effectiveness and Evaluation Unit, Royal College of Physicians, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Wakeman
authors.affiliation: National Hip Fracture Database, Falls and Fragility Fracture Audit Programme, Clinical Effectiveness and Evaluation Unit, Royal College of Physicians, London, UK.
authors.forename: C
authors.initials: C
authors.lastname: Boulton
authors.affiliation: The Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK.
authors.forename: F
authors.initials: F
authors.lastname: Plant
authors.affiliation: Gloucestershire Royal Hospital, Gloucester, Gloucestershire, UK.
authors.forename: A
authors.initials: A
authors.lastname: Williams
authors.affiliation: Association of Anaesthetists of Great Britain and Ireland, London, UK.
authors.forename: K
authors.initials: K
authors.lastname: Pappenheim
authors.affiliation: King Fahad Medical City, Riyadh, Saudi Arabia.
authors.forename: A
authors.initials: A
authors.lastname: Majeed
authors.affiliation: National Hip Fracture Database, London, UK.
authors.forename: C T
authors.initials: CT
authors.lastname: Currie
authors.affiliation: Anaesthesia and Critical Care Medicine, University of Southampton and Southampton NIHR Respiratory Biomedical Research Unit, Southampton, UK.
authors.forename: M P W
authors.initials: MP
authors.lastname: Grocott
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia / Q000379:methods*; D000768:Anesthesia, General; D000775:Anesthesia, Spinal; D001794:Blood Pressure; D054869:Clinical Audit; D015897:Comorbidity; D016292:Procedural Sedation; D005260:Female; D006620:Hip Fractures / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
keywords: aging: cardiovascular physiology; lspinal anesthaesia: complications; spinal hypotension: treatment