The effect of anesthetic technique on mortality and major morbidity after hip fracture surgery: a retrospective, propensity-score matched-pairs cohort study

2019 ◽  
Vol 44 (9) ◽  
pp. 847-853 ◽  
Author(s):  
Laith Malhas ◽  
Anahi Perlas ◽  
Sarah Tierney ◽  
Vincent W S Chan ◽  
Scott Beattie
Keyword(s):  
Cohort Study ◽  
Hip Fracture ◽  
Length Of Stay ◽  
Propensity Score ◽  
Blood Loss ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Anesthetic Technique ◽  
Hip Fracture Surgery ◽  
Fracture Surgery

IntroductionSpinal anesthesia (SA) has physiological benefits over general anesthesia (GA), but there is insufficient evidence regarding a mortality benefit. We performed a retrospective propensity score-matched cohort study to evaluate the impact of anesthetic technique on mortality and major morbidity in patients undergoing hip fracture surgery.Materials and methodsClinical, laboratory and outcome data were extracted from electronic databases for patients who underwent hip fracture surgery over a 13-year period at the University Health Network in Toronto, Ontario, Canada. The anesthetic technique was documented (SA or GA), and the primary outcome was 90-day mortality. Secondary outcomes included mortality at 30 and 60 days, hospital length of stay, pulmonary embolism (PE), major blood loss and major acute cardiac events. A propensity-score matched-pair analysis was performed following a non-parsimonious logistic regression model.ResultsOf the 2591 patients identified, 883 patients in the SA group were matched to patients in the GA group in a 1:1 ratio. There was a weak association between SA and lower 90-day mortality (risk ratio (RR) 0.74, 95% CI 0.52 to 0.96, 99% CI 0.48 to 1.00, p=0.037). SA was also associated with a lower incidence of both PE (1.3% vs 0.5%, p<0.001) and major blood loss (7.7% vs 4.8%, p<0.001) and a shorter hospital length of stay by about 2 days (median 11.9 vs 10 days, p=0.024). There was no difference in major cardiac events or mortality at 30 and 60 days.DiscussionThis propensity-score matched-pairs cohort study suggests that SA is weakly associated with a lower 90-day mortality following hip fracture surgery. SA was also associated with improved morbidity evidenced by a lower rate of PE and major blood loss and a shorter hospital length of stay. Given the retrospective nature of the study, these results are not proof of causality.

Delay in Hip Fracture Surgery Prolongs Postoperative Hospital Length of Stay but Does Not Adversely Affect Outcomes at 30 Days

2018 ◽  
Vol 32 (12) ◽  
pp. 629-633 ◽  
Author(s):  
Sean M. Mitchell ◽  
Andrew S. Chung ◽  
Joseph B. Walker ◽  
Joshua W. Hustedt ◽  
George V. Russell ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Hip Fracture Surgery ◽  
Fracture Surgery

scholarly journals Impact of Diabetes Mellitus on Early Postoperative Outcomes After Hip Fracture Surgery in Geriatric Patients: A Retrospective, Propensity Score Matching Study

2021 ◽  
Author(s):  
Ruibo Li ◽  
Xingyue Yuan ◽  
Yuehong Liu ◽  
Shuping Liu ◽  
Yu Zhou ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Hip Fracture ◽  
Blood Transfusion ◽  
Length Of Stay ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Hospital Costs ◽  
Hip Fracture Surgery ◽  
Fracture Surgery ◽  
Total Charges

Abstract Background：The impact of diabetes mellitus (DM) on hip fracture (HF) is still controversial. The primary aim of this study was to examine the influence of DM on perioperative transfusion， the secondary aims were to evaluate 1-year mortality, length of stay，and total charges in individuals with hip fracture.Methods: All patients with initial HF aged 60 years or older admitted to our hospital from January 2014 to January 2018 were eligible for this study. After excluding some patients who did not meet the experimental requirements, 326 HF patients aged 60 years and above were admitted to the study institution, and were divided into DM group (n=71) and non-diabetes mellitus (non-DM) group (n=255). Sex, age, American Society of Anesthesiologists (ASA) classification, anesthesia type and surgery type were matched in the two groups (DM group vs. non-DM group) using propensity score matching (PSM) without any statistical differences. Then，perioperative transfusion，length of stay，direct total charges and 1-year mortality in individuals with HF were compared between two groups.Results: Following PSM, 62 patients in the DM group and 62 patients in the non-DM group were included in the study. Twenty-eight patients had received blood transfusion during the perioperative period, the difference in blood transfusion rate between two groups was statistically significant (p=0.032). There were no statistical differences in 1-year mortality, length of stay and direct hospital costs between two groups.Conclusions: This study showed that DM patients with hip fractures have a higher probability of receiving transfusions compared to patients without DM. Higher blood transfusion rates may be associated with lower hemoglobin and hematocrit levels at admission. However, there was no significant increase in 1-year mortality, length of hospital stay, and direct hospital costs after hip fracture surgery due to diabetes.

scholarly journals The independent patient factors that affect length of stay following hip fractures

2018 ◽  
Vol 100 (7) ◽  
pp. 556-562 ◽  
Author(s):  
T Richards ◽  
A Glendenning ◽  
D Benson ◽  
S Alexander ◽  
S Thati
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Hip Fractures ◽  
Length Of Hospital Stay ◽  
Hospital Length ◽  
Acute Hospital ◽  
Hospital Length Of Stay ◽  
Patient Factors ◽  
Mobility Status

Introduction Management of hip fractures has evolved over recent years to drive better outcomes including length of hospital stay. We aimed to identify and quantify the effect that patient factors influence acute hospital and total health service length of stay. Methods A retrospective observational study based on National Hip Fracture Database data was conducted from 1 January 2014 to 31 December 2015. A multiple regression analysis of 330 patients was carried out to determine independent factors that affect acute hospital and total hospital length of stay. Results American Society of Anesthesiologists (ASA) grade 3 or above, Abbreviated Mental Test Score (AMTS) less than 8 and poor mobility status were independent factors, significantly increasing length of hospital stay in our population. Acute hospital length of stay can be predicted as 8.9 days longer when AMTS less than 8, 4.2 days longer when ASA grade was 3 or above and 20.4 days longer when unable to mobilise unaided (compared with independently mobile individuals). Other factors including total hip replacement compared with hemiarthroplasty did not independently affect length of stay. Conclusions Our analysis in a representative and generalisable population illustrates the importance of identifying these three patient characteristics in hip fracture patients. When recognised and targeted with orthogeriatric support, the length of hospital stay for these patients can be reduced and overall hip fracture care improved. Screening on admission for ASA grade, AMTS and mobility status allows prediction of length of stay and tailoring of care to match needs.

scholarly journals Anesthesia Technique, Mortality, and Length of Stay After Hip Fracture Surgery

JAMA ◽  
2014 ◽  
Vol 311 (24) ◽  
pp. 2508 ◽  
Author(s):  
Mark D. Neuman ◽  
Paul R. Rosenbaum ◽  
Justin M. Ludwig ◽  
Jose R. Zubizarreta ◽  
Jeffrey H. Silber
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Hip Fracture Surgery ◽  
Anesthesia Technique ◽  
Fracture Surgery

scholarly journals Hip Fractures in Centenarians: Has Care Improved in the National Hip Fracture Database Era?

2017 ◽  
Vol 8 (3) ◽  
pp. 161-165 ◽  
Author(s):  
Alastair G. Dick ◽  
Dominic Davenport ◽  
Mohit Bansal ◽  
Therese S. Burch ◽  
Max R. Edwards
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Hip Fractures ◽  
District General Hospital ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Retrospective Case ◽  
Time To Surgery ◽  
Surgery Mortality ◽  
Hospital Acquired

Introduction: The number of centenarians in the United Kingdom is increasing. An associated increase in the incidence of hip fractures in the extreme elderly population is expected. The National Hip Fracture Database (NHFD) initiative was introduced in 2007 aiming to improve hip fracture care. There is a paucity of literature on the outcomes of centenarians with hip fractures since its introduction. The aim of this study is to report our experience of hip fractures in centenarians in the era since the introduction of the NHFD to assess outcomes in terms of mortality, time to surgery, length of stay, and complications. Methods: A retrospective case note study of all centenarians managed for a hip fracture over a 7-year period at a London district general hospital. Results: We report on 22 centenarians sustaining 23 hip fractures between 2008 and 2015. Twenty-one fractures were managed operatively. For patients managed operatively, in-hospital, 30-day, 3-month, 6-month, 1-year, 2-year, 3-year, and 5-year cumulative mortalities were 30%, 30%, 39%, 50%, 77%, 86%, 95%, and 100%, respectively. In-hospital mortality was 100% for those managed nonoperatively. Mean time to surgery was 1.6 days (range: 0.7-6.3 days). Mean length of stay on the acute orthopedic ward was 23 days (range: 2-51 days). Seventy-one percent had a postoperative complication most commonly a hospital-acquired pneumonia or urinary tract infection. Conclusion: Compared to a series of centenarians with hip fractures prior to the introduction of the NHFD, we report a reduced time to surgery. Mortality and hospital length of stay were similar.

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