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Regional anesthesia reduces complications, mortality for hip fracture patients

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The use of regional anesthesia vs. general anesthesia was associated with a significant reduction in major pulmonary complications and death in patients undergoing surgery for hip fracture, according to a study of more than 18,000 patients.

“Hip fracture is a common and costly event among older adults,” lead study author Mark D. Neuman, MD, stated in a University of Pennsylvania School of Medicine news release. “One out of five hip fracture patients dies within a year of their injury. There is an urgent need for better information to guide patients and clinicians to make decisions about anesthesia for hip fracture surgery, but so far very few large observational studies in the general population have examined this issue.”

The study, set to be published in Anesthesiology, was performed by researchers at the Perelman School of Medicine at the University of Pennsylvania.

According to the study abstract, the authors retrospectively assessed a cohort of patients in 126 New York hospitals who underwent surgery for hip fracture in 2007 and 2008. The use of regional or general anesthesia was noted, with inpatient mortality being the primary outcome and pulmonary and cardiovascular complications being the secondary outcomes.

The authors reported that of 18,158 patients, 5,254 (29%) received regional anesthesia, with in-hospital mortality occurring in a total of 435 patients (2.4%). Those patients who received regional anesthesia were found to have 29% lower adjusted odds of mortality when compared to those patients who received general anesthesia.

According to the release, the authors also found a 24% decrease in the adjusted odds of any inpatient pulmonary complication occurring when regional anesthesia was used.

The authors suggested in the abstract that a trend toward improved outcomes for patients with intertrochanteric fractures receiving regional anesthesia may be driving the findings.

Reference:

• Neuman MD, Silber JH, Elkassabany NM, et al. Comparative effectiveness of regional versus general anesthesia for hip fracture surgery in adults. Anesthesiology. 2012. doi:10.1097/ALN.0b013e3182545e7c