scholarly journals Comparative Effectiveness of Regional versus  General Anesthesia for Hip Fracture Surgery in Adults

2012 ◽  
Vol 117 (1) ◽  
pp. 72-92 ◽  
Author(s):  
Mark D. Neuman ◽  
Jeffrey H. Silber ◽  
Nabil M. Elkassabany ◽  
Justin M. Ludwig ◽  
Lee A. Fleisher
Keyword(s):  
Hip Fracture ◽  
General Anesthesia ◽  
Regional Anesthesia ◽  
Odds Ratio ◽  
Cardiovascular Complications ◽  
Pulmonary Complications ◽  
Inpatient Mortality ◽  
Hip Fracture Surgery ◽  
Subgroup Analyses ◽  
Fracture Surgery

Background Hip fracture is a common, morbid, and costly event among older adults. Data are inconclusive as to whether epidural or spinal (regional) anesthesia improves outcomes after hip fracture surgery. Methods The authors examined a retrospective cohort of patients undergoing surgery for hip fracture in 126 hospitals in New York in 2007 and 2008. They tested the association of a record indicating receipt of regional versus general anesthesia with a primary outcome of inpatient mortality and with secondary outcomes of pulmonary and cardiovascular complications using hospital fixed-effects logistic regressions. Subgroup analyses tested the association of anesthesia type and outcomes according to fracture anatomy. Results Of 18,158 patients, 5,254 (29%) received regional anesthesia. In-hospital mortality occurred in 435 (2.4%). Unadjusted rates of mortality and cardiovascular complications did not differ by anesthesia type. Patients receiving regional anesthesia experienced fewer pulmonary complications (359 [6.8%] vs. 1,040 [8.1%], P < 0.005). Regional anesthesia was associated with a lower adjusted odds of mortality (odds ratio: 0.710, 95% CI 0.541, 0.932, P = 0.014) and pulmonary complications (odds ratio: 0.752, 95% CI 0.637, 0.887, P < 0.0001) relative to general anesthesia. In subgroup analyses, regional anesthesia was associated with improved survival and fewer pulmonary complications among patients with intertrochanteric fractures but not among patients with femoral neck fractures. Conclusions Regional anesthesia is associated with a lower odds of inpatient mortality and pulmonary complications among all hip fracture patients compared with general anesthesia; this finding may be driven by a trend toward improved outcomes with regional anesthesia among patients with intertrochanteric fractures.

scholarly journals Postoperative Delirium in Elderly Patients Undergoing Hip Fracture Surgery in the Sugammadex Era: A Retrospective Study

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Chung-Sik Oh ◽  
Ka Young Rhee ◽  
Tae-Gyoon Yoon ◽  
Nam-Sik Woo ◽  
Seung Wan Hong ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Elderly Patients ◽  
General Anesthesia ◽  
Cholinesterase Inhibitor ◽  
Postoperative Delirium ◽  
Neuromuscular Block ◽  
Pulmonary Complications ◽  
Laboratory Findings ◽  
Hip Fracture Surgery ◽  
Fracture Surgery

Background.Residual neuromuscular block (NMB) after general anesthesia has been associated with pulmonary dysfunction and hypoxia, which are both associated with postoperative delirium (POD). We evaluated the effects of sugammadex on POD in elderly patients who underwent hip fracture surgery.Methods.Medical records of 174 consecutive patients who underwent hip fracture surgery with general anesthesia were reviewed retrospectively to compare the perioperative incidence of POD, pulmonary complications, time to extubation, incidence of hypoxia, and laboratory findings between patients treated with sugammadex and those treated with a conventional cholinesterase inhibitor.Results.The incidence of POD was not significantly different between the two groups (33.3% versus 36.5%, resp.;P=0.750). Postoperative pulmonary complications and laboratory findings did not showed significant intergroup difference. However, time to extubation (6 ± 3 versus 8 ± 3 min;P<0.001) and the frequency of postoperative hypoxia were significantly lower (23% versus 43%;P=0.010) in the sugammadex group than in the conventional cholinesterase inhibitor group.Conclusion.Sugammadex did not reduce POD or pulmonary complications compared to conventional cholinesterase inhibitors, despite reducing time to extubation and postoperative hypoxia in elderly patients who underwent hip fracture surgery under general anesthesia.

scholarly journals Pilot Randomized Controlled Trial of Spinal Versus General Anesthesia for Hip Fracture Surgery

2016 ◽  
Vol 64 (12) ◽  
pp. 2604-2606 ◽  
Author(s):  
Mark D. Neuman ◽  
Samir Mehta ◽  
Evan R. Bannister ◽  
Patrick J. Hesketh ◽  
Annamarie D. Horan ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Hip Fracture ◽  
General Anesthesia ◽  
Controlled Trial ◽  
Hip Fracture Surgery ◽  
Randomized Controlled ◽  
Fracture Surgery ◽  
Pilot Randomized Controlled Trial

scholarly journals Comparative Efficacy of Neuraxial and General anesthesia for hip fracture surgery: A meta-analysis of randomized clinical trials

2019 ◽  
Author(s):  
Xinxun Zheng ◽  
Yuming Tang ◽  
Yuan Gao ◽  
Zhiheng Liu
Keyword(s):  
Hip Fracture ◽  
Blood Loss ◽  
General Anesthesia ◽  
Sample Size ◽  
Meta Analysis ◽  
Neuraxial Anesthesia ◽  
Perioperative Outcomes ◽  
Hip Fracture Surgery ◽  
Evidence Quality ◽  
Fracture Surgery

Abstract Background: The choice of anesthesia technique remains debatable in patients undergoing surgical repair of hip fracture. This meta-analysis was performed to compare the effect of neuraxial (epidural/spinal) versus general anesthesia on perioperative outcomes in patients undergoing hip fracture surgery. Methods: Medline, Cochrane Library, Science-Direct, and EMBASE databases were searched to identify eligible studies focused on the comparison between neuraxial and general anesthesia in hip fracture patients between January 2000 and May 2019. Perioperative outcomes were extracted for systemic analysis. The sensitivity analyses were performed by the leave-one-out approach. The evidence quality for each outcome was evaluated by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Results: Nine randomized controlled trials (RCTs) including 1084 patients fulfilled our selection criteria. The results showed that there were no significant differences in the 30-day mortality, length of stay, and the prevalence of delirium, acute myocardial infarction, and pneumonia for neuraxial anesthesia compared to general anesthesia. There was a significant difference in terms of blood loss in favor of the neuraxial anesthesia. The evidence quality for each outcome evaluated by the GRADE system was low. Conclusions: In summary, our present study demonstrated that neuraxial anesthesia is significantly superior to general anesthesia regarding blood loss in patients undergoing hip fracture surgery. Due to small sample size and enormous inconsistency in the choice of outcome measures, more high-quality studies with large sample size are needed to to clarify this issue.

scholarly journals Comparative Efficacy of Neuraxial and General anesthesia for hip fracture surgery: A meta-analysis of randomized clinical trials

2020 ◽  
Author(s):  
Xinxun Zheng ◽  
Yuming Tang ◽  
Yuan Gao ◽  
Zhiheng Liu
Keyword(s):  
Hip Fracture ◽  
Blood Loss ◽  
General Anesthesia ◽  
Sample Size ◽  
Meta Analysis ◽  
Neuraxial Anesthesia ◽  
Perioperative Outcomes ◽  
Hip Fracture Surgery ◽  
Evidence Quality ◽  
Fracture Surgery

Abstract Background: The choice of anesthesia technique remains debatable in patients undergoing surgical repair of hip fracture. This meta-analysis was performed to compare the effect of neuraxial (epidural/spinal) versus general anesthesia on perioperative outcomes in patients undergoing hip fracture surgery.Methods: Medline, Cochrane Library, Science-Direct, and EMBASE databases were searched to identify eligible studies focused on the comparison between neuraxial and general anesthesia in hip fracture patients between January 2000 and May 2019. Perioperative outcomes were extracted for systemic analysis. The sensitivity analyses were performed by the leave-one-out approach. The evidence quality for each outcome was evaluated by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.Results: Nine randomized controlled trials (RCTs) including 1084 patients fulfilled our selection criteria. The results showed that there were no significant differences in the 30-day mortality (OR = 1.34, 95% CI 0.56, 3.21; P = 0.51), length of stay (MD = -0.65, 95% CI -0.32, 0.02; P =0.06), and the prevalence of delirium (OR = 1.05, 95% CI 0.27, 4.00; P = 0.95), acute myocardial infarction (OR = 0.88, 95% CI 0.17, 4.65; P = 0.88), deep venous thrombosis (OR = 0.48, 95% CI 0.09, 2.72; P = 0.41), and pneumonia (OR = 1.04, 95% CI 0.23, 4.61; P = 0.96) for neuraxial anesthesia compared to general anesthesia. There was a significant difference in terms of blood loss in favor of the neuraxial anesthesia (MD = -137.8, 95% CI -241.49, -34.12; p = 0.009). The evidence quality for each outcome evaluated by the GRADE system was low.Conclusions: In summary, our present study demonstrated that neuraxial anesthesia is associated with a reduced blood loss in patients undergoing hip fracture surgery compared to general anesthesia. However, this result was underpowered. Due to small sample size and enormous inconsistency in the choice of outcome measures, more high-quality studies with large sample size are needed to clarify this issue

scholarly journals Comparative Efficacy of Neuraxial and General anesthesia for hip fracture surgery: A meta-analysis of randomized clinical trials

2020 ◽  
Author(s):  
Xinxun Zheng ◽  
Yuming Tang ◽  
Yuan Gao ◽  
Zhiheng Liu
Keyword(s):  
Hip Fracture ◽  
Blood Loss ◽  
General Anesthesia ◽  
Multiple Testing ◽  
Meta Analysis ◽  
Perioperative Outcomes ◽  
Bonferroni Correction ◽  
Hip Fracture Surgery ◽  
Evidence Quality ◽  
Fracture Surgery

Abstract Background: The choice of anesthesia technique remains debatable in patients undergoing surgical repair of hip fracture. This meta-analysis was performed to compare the effect of neuraxial (epidural/spinal) versus general anesthesia on perioperative outcomes in patients undergoing hip fracture surgery.Methods: Medline, Cochrane Library, Science-Direct, and EMBASE databases were searched to identify eligible studies focused on the comparison between neuraxial and general anesthesia in hip fracture patients between January 2000 and May 2019. Perioperative outcomes were extracted for systemic analysis. The sensitivity analyses were conducted using a Bonferroni correction and the leave-one-out method. The evidence quality for each outcome was evaluated by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.Results: Nine randomized controlled trials (RCTs) including 1084 patients fulfilled our selection criteria. The outcomes for the meta-analysis showed that there were no significant differences in the 30-day mortality (OR = 1.34, 95% CI 0.56, 3.21; P = 0.51), length of stay (MD = -0.65, 95% CI -0.32, 0.02; P =0.06), and the prevalence of delirium (OR = 1.05, 95% CI 0.27, 4.00; P = 0.95), acute myocardial infarction (OR = 0.88, 95% CI 0.17, 4.65; P = 0.88), deep venous thrombosis (OR = 0.48, 95% CI 0.09, 2.72; P = 0.41), and pneumonia (OR = 1.04, 95% CI 0.23, 4.61; P = 0.96) for neuraxial anesthesia compared to general anesthesia, and there was a significant difference in blood loss between the two groups (MD = -137.8, 95% CI -241.49, -34.12; p = 0.009). However, after applying the Bonferroni correction for multiple testing, all the adjusted p-values were above the significant threshold of 0.05. The evidence quality for each outcome evaluated by the GRADE system was low.Conclusions: In summary, our present study demonstrated that there might be a difference in blood loss between patients receiving neuraxial and general anaesthesia, however, this analysis was not robust to adjustment for multiple testing and therefore at high risk for a type I error. Due to small sample size and enormous inconsistency in the choice of outcome measures, more high-quality studies with large sample size are needed to clarify this issue.

scholarly journals Hospital-, Anesthesiologist-, and Patient-level Variation in Primary Anesthesia Type for Hip Fracture Surgery

2018 ◽  
Vol 129 (6) ◽  
pp. 1121-1131 ◽  
Author(s):  
Daniel I. McIsaac ◽  
Duminda N. Wijeysundera ◽  
Gregory L. Bryson ◽  
Allen Huang ◽  
Colin J. L. McCartney ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Odds Ratio ◽  
Antiplatelet Agents ◽  
Neuraxial Anesthesia ◽  
Hospital Level ◽  
Patient Factors ◽  
Cross Sectional ◽  
Hip Fracture Surgery ◽  
Patient Level ◽  
Fracture Surgery

Abstract Editor’s Perspective What We Already Know about This Topic What This Manuscript Tells Us That Is New Background Substantial variation in primary anesthesia type for hip fracture surgery exists. Previous work has demonstrated that patients cared for at hospitals using less than 20 to 25% neuraxial anesthesia have decreased survival. Therefore, the authors aimed to identify sources of variation in anesthesia type, considering patient-, anesthesiologist-, and hospital-level variables. Methods Following protocol registration (NCT02787031), the authors conducted a cross-sectional analysis of a population-based cohort using linked administrative data in Ontario, Canada. The authors identified all people greater than 65 yr of age who had emergency hip fracture surgery from April 2002 to March 2014. Generalized linear mixed models were used to account for hierarchal data and measure the adjusted association of hospital-, anesthesiologist-, and patient-level factors with neuraxial anesthesia use. The proportion of variation attributable to each level was estimated using variance partition coefficients and the median odds ratio for receipt of neuraxial anesthesia. Results Of 107,317 patients, 57,080 (53.2%) had a neuraxial anesthetic. The median odds ratio for receiving neuraxial anesthesia was 2.36 between randomly selected hospitals and 2.36 between randomly selected anesthesiologists. The majority (60.1%) of variation in neuraxial anesthesia use was explained by patient factors; 19.9% was attributable to the anesthesiologist providing care and 20.0% to the hospital where surgery occurred. The strongest patient-level predictors were absence of preoperative anticoagulant or antiplatelet agents, absence of obesity, and presence of pulmonary disease. Conclusions While patient factors explain most of the variation in neuraxial anesthesia use for hip fracture surgery, 40% of variation is attributable to anesthesiologist and hospital-level practice. Efforts to change practice patterns will need to consider hospital-level processes and anesthesiologists’ intentions and behaviors.

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