title: Similar mortality with general or regional anesthesia in elderly hip fracture patients.
abstract: OBJECTIVE
  There is continuing confusion among practitioners with regard to the optimal choice of anesthetic type for repair of hip fractures. We investigated whether type of anesthetic was associated with short-term mortality after hip fracture surgery.
  
  
  METHODS
  We conducted a retrospective cohort study of patients with surgically treated hip fractures, performed between January 1, 2009 and December 31, 2012. Exposure of interest was anesthesia type (general, spinal/neuroaxial, and mixed). Endpoints were 30-, 90-, and 365-day post-surgery mortality. Multivariable conditional logistic regression models were used and odds ratios (ORs) and 95% confidence intervals (CIs) are reported.
  
  
  RESULTS
  Of the 7,585 participants, 5,412 (71%) were women and the median age was 80 (IQR: 72-85) years old. Of the total cohort, 4,257 (56%) received general anesthesia, 3,059 (40%) received spinal/neuroaxial, and 269 (4%) received mixed anesthesia. Overall, the incidence of 30-, 90-, and 365-day mortality was 4% (n = 307), 8% (n = 583), and 15% (n = 1,126), respectively. When compared with general anesthesia, the 365-day odds of mortality was marginally lower in patients with spinal/neuroaxial anesthesia (OR = 0.84, CI: 0.70-1.0), but it was similar in patients with mixed anesthesia (OR = 1.3, CI: 0.70-2.3). No other statistically significant differences were observed.
  
  
  CONCLUSIONS
  Regarding mortality, this study does not support specific recommendations regarding the type of anesthetic in surgery of fractured hips.
authors.affiliation: a The Permanente Medical Group, Kaiser Permanente , Fresno .
authors.forename: W Timothy
authors.initials: WT
authors.lastname: Brox
authors.affiliation: b Surgical Outcomes and Analysis Department , Kaiser Permanente , San Diego , CA.
authors.forename: Priscilla H
authors.initials: PH
authors.lastname: Chan
authors.affiliation: b Surgical Outcomes and Analysis Department , Kaiser Permanente , San Diego , CA.
authors.forename: Guy
authors.initials: G
authors.lastname: Cafri
authors.affiliation: b Surgical Outcomes and Analysis Department , Kaiser Permanente , San Diego , CA.
authors.forename: Maria C S
authors.initials: MC
authors.lastname: Inacio
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000765:Anesthesia, Conduction / Q000401:mortality*; D000768:Anesthesia, General / Q000401:mortality*; D000775:Anesthesia, Spinal / Q000401:mortality; D002140:California / Q000453:epidemiology; D005260:Female; D006620:Hip Fractures / Q000401:mortality* / Q000601:surgery; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome