Mode of anesthesia is not associated with outcomes following emergency hip fracture surgery: a population-level cohort study

Trauma Surgery & Acute Care Open

article

Ahmad Mohammad Ismail¹  Maximilian Peter Forssten¹  Gary Alan Bass³  Dhanisha Jayesh Trivedi²  Lovisa Ekestubbe⁴  Ioannis Ioannidis¹  Caoimhe C Duffy⁵  Carol J Peden⁶  Shahin Mohseni² 

[1] Department of Orthopedic Surgery , Orebro University Hospital;School of Medical Sciences , Orebro University;Division of Traumatology, Surgical Critical Care and Emergency Surgery , University of Pennsylvania Perelman School of Medicine;Division of Trauma and Emergency Surgery, Department of Surgery , Orebro University Hospital;Perelman School of Medicine , University of Pennsylvania;Department of Clinical Anesthesiology , University of Southern California Keck School of Medicine;Department of Anesthesiology , University of Pennsylvania

关键词: anesthesia;    hip fractures;    postoperative complications;    mortality;   

DOI  :  10.1136/tsaco-2022-000957

学科分类：社会科学、人文和艺术（综合）

来源: BMJ Publishing Group

【 摘 要 】

Background Hip fractures often occur in frail patients with several comorbidities. In those undergoing emergency surgery, determining the optimal anesthesia modality may be challenging, with equipoise concerning outcomes following either spinal or general anesthesia. In this study, we investigated the association between mode of anesthesia and postoperative morbidity and mortality with subgroup analyses.Methods This is a retrospective study using all consecutive adult patients who underwent emergency hip fracture surgery in Orebro County, Sweden, between 2013 and 2017. Patients were extracted from the Swedish National Hip Fracture Registry, and their electronic medical records were reviewed. The association between the type of anesthesia and 30-day and 90-day postoperative mortality, as well as in-hospital severe complications (Clavien-Dindo classification ≥3a), was analyzed using Poisson regression models with robust SEs, while the association with 1-year mortality was analyzed using Cox proportional hazards models. All analyses were adjusted for potential confounders.Results A total of 2437 hip fracture cases were included in the study, of whom 60% received spinal anesthesia. There was no statistically significant difference in the risk of 30-day postoperative mortality (adjusted incident rate ratio (IRR) (95% CI): 0.99 (0.72 to 1.36), p=0.952), 90-day postoperative mortality (adjusted IRR (95% CI): 0.88 (0.70 to 1.11), p=0.281), 1-year postoperative mortality (adjusted HR (95% CI): 0.98 (0.83 to 1.15), p=0.773), or in-hospital severe complications (adjusted IRR (95% CI): 1.24 (0.85 to 1.82), p=0.273), when comparing general and spinal anesthesia.Conclusions Mode of anesthesia during emergency hip fracture surgery was not associated with an increased risk of postoperative mortality or in-hospital severe complications in the study population or any of the investigated subgroups.

【 授权许可】

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