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Desai V, Chan PH, Royse KE, Navarro RA, Diekmann GR, Yamaguchi KT, Paxton EW, Qiu C. Factors Associated with Mortality and Short-Term Patient Outcomes for Hip Fracture Repair in the Elderly Based on Preoperative Anticoagulation Status. Geriatrics (Basel) 2025; 10:54. [PMID: 40277853 PMCID: PMC12026724 DOI: 10.3390/geriatrics10020054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2025] [Revised: 03/19/2025] [Accepted: 04/02/2025] [Indexed: 04/26/2025] Open
Abstract
Background: The one-year mortality risk for elderly patients undergoing proximal femur fracture repair surgery is three to four times higher compared to the general population. Other than time to surgery, risk factors for postoperative morbidity and mortality following surgery are poorly understood in the elderly. We sought to identify risk factors associated with morbidity and mortality in geriatric patients by anticoagulation status undergoing hip fracture repair. Methods: Patients aged ≥65 years undergoing surgery for hip fracture repair were included (2009-2019) from a US-based hip fracture registry. Factors associated with 90-day mortality were determined using multivariable logistic regression and stratified by antithrombotic agent medication use prior to surgery. Direct oral anticoagulation (DOAC) medications were the largest group, and all antithrombotic agents were included in the delineation. Results: A total of 35,463 patients were identified, and 87.1% (N = 30,902) were DOAC-naïve. Risk factors for 90-day mortality in DOAC-naïve patients were an American Society of Anesthesiologist's (ASA) classification ≥3 (odds ratio [OR] = 2.56, 95% confidence interval [CI] = 2.24-2.93), preoperative myocardial infarction (OR = 1.87, 95% CI = 1.33-2.64), male gender (OR = 1.73, 95% CI = 1.59-1.88), congestive heart failure (CHF) (OR = 1.64, 95% CI = 1.50-1.80), psychoses (OR = 1.27, 95% CI = 1.15-1.42), renal failure (OR = 1.29, 95% CI = 1.19-1.40), smoking history (OR = 1.19, 95% CI = 1.09-1.29), chronic pulmonary disease (OR = 1.14, 95% CI = 1.05-1.25), increasing age (OR = 1.07, 95% CI = 1.06-1.07), and decreasing body mass index (BMI) (OR = 1.06, 95% CI = 1.05-1.08). Identified factors for mortality in the DOAC group also included ASA classification ≥3 (OR = 2.15, 95% CI = 1.44-3.20), male gender (OR = 1.68, 95% CI = 1.41-2.01), CHF (OR = 1.45, 95% CI = 1.22-1.73), chronic pulmonary disease (OR = 1.34, 95% CI = 1.12-1.61), decreasing BMI (OR = 1.04, 95% CI = 1.02-1.06), and increasing age (OR = 1.02, 95% CI = 1.01-1.03). Conclusions: Regardless of preoperative DOAC status, ASA classification, gender, CHF, chronic pulmonary disease, lower BMI, and higher age are associated with an increased risk of mortality. Some of these comorbidities can be utilized for risk stratification prior to surgery.
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Affiliation(s)
- Vimal Desai
- Department of Anesthesiology, Kaiser Permanente, Baldwin Park, CA 91706, USA; (V.D.); (C.Q.)
| | - Priscilla H. Chan
- Medical Device Surveillance & Assessment, Kaiser Permanente, San Diego, CA 92108, USA (E.W.P.)
| | - Kathryn E. Royse
- Medical Device Surveillance & Assessment, Kaiser Permanente, San Diego, CA 92108, USA (E.W.P.)
| | - Ronald A. Navarro
- Department of Orthopedics, Kaiser Permanente, Harbor City, CA 90710, USA
| | - Glenn R. Diekmann
- Department of Orthopedics, Kaiser Permanente, Baldwin Park, CA 91706, USA
| | - Kent T. Yamaguchi
- Department of Orthopedics, Kaiser Permanente, Santa Rosa, CA 95403, USA
| | - Elizabeth W. Paxton
- Medical Device Surveillance & Assessment, Kaiser Permanente, San Diego, CA 92108, USA (E.W.P.)
| | - Chunyuan Qiu
- Department of Anesthesiology, Kaiser Permanente, Baldwin Park, CA 91706, USA; (V.D.); (C.Q.)
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Suwal A, Subedi N, Shrestha N, Shrestha U. Pericapsular nerve group block followed by regional anesthesia for pathological fracture fixation in a multiple myeloma patient. Clin Case Rep 2024; 12:e9374. [PMID: 39210924 PMCID: PMC11358699 DOI: 10.1002/ccr3.9374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 07/23/2024] [Accepted: 07/31/2024] [Indexed: 09/04/2024] Open
Abstract
Appropriate anesthetic technique for fracture fixation in multiple myeloma is crucial in minimizing perioperative complications. The use of pericapsular nerve group block followed by spinal anesthesia for the operative management of pathological fracture in multiple myeloma patient along with proper pre- and postanesthetic care ensures better outcome for the patient. Abstract Multiple myeloma is a malignant plasma cell disease that often presents with anemia, renal failure, hyperkalemia and osteolytic bone lesions. The advancements in drug therapy of multiple myeloma have prolonged the lifespan of the affected people, resulting in a rise in cases of surgical management of fractures in such patients. Anesthetic management, despite being of utmost importance in minimizing perioperative complications in such patients, has not been widely studied, especially in this part of the world. Hence, we report a case of 64 years diabetic, HbSAg positive male with hypothyroidism and a known case of multiple myeloma since the last 6 years, under medication for his comorbidities who suffered acetabular fracture. In this case report, the use of pericapsular nerve group block followed by spinal anesthesia for the operative management of the fracture has been discussed along with several pre- and postanesthetic considerations. With appropriate anesthetic techniques and proper pre- and postanesthetic care, better outcomes can be guaranteed.
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Affiliation(s)
- Aayusha Suwal
- Kathmandu Medical College and Teaching HospitalKathmanduNepal
| | - Nischal Subedi
- Kathmandu Medical College and Teaching HospitalKathmanduNepal
| | | | - Ujma Shrestha
- Department of AnesthesiologyKathmandu Medical College and Teaching HospitalKathmanduNepal
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Qian D, Olumuyide E, Keswani A, Lin HM, Ouyang Y, DeMaria S, Poeran J, Park CH, Burnett GW. The Impact of Race/Ethnicity on Disparities in Utilization and Outcomes of Neuraxial Anesthesia for Hip and Femoral Shaft Fractures. J Clin Med 2024; 13:3999. [PMID: 39064039 PMCID: PMC11277043 DOI: 10.3390/jcm13143999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 07/01/2024] [Accepted: 07/06/2024] [Indexed: 07/28/2024] Open
Abstract
Background/Objectives: The use of neuraxial anesthesia versus general anesthesia for hip fracture surgery remains an active area of research, with recent studies demonstrating mixed findings supporting neuraxial over general anesthesia. The benefits of neuraxial anesthesia have been documented in associated surgeries, including total joint arthroplasty. However, racial disparities in the administration of neuraxial anesthesia have been identified in numerous procedures. We aimed to examine the association of race/ethnicity with neuraxial anesthesia use and the effect of neuraxial anesthesia on length of stay, non-home discharge, 30-day severe adverse events, and rates of readmission among patients undergoing isolated hip and femoral shaft fracture operations. Methods: The American College of Surgeons National Quality Improvement Program database was queried for isolated hip or femoral shaft fractures from 2015 to 2019. Stepwise logistic regression was performed to assess the relationship between race/ethnicity and neuraxial anesthesia use. Within each sex-race stratum, neuraxial anesthesia recipients were propensity-matched to general anesthesia recipients in a 1:2 ratio. Logistic regression and negative binomial regression were performed on the propensity-matched cohort. Results: A total of 12,004 neuraxial and 64,250 general anesthesia hip and femoral shaft fracture patients were identified. Compared to White patients, Black and Hispanic patients were between 0.64 and 0.61 times less likely to receive neuraxial anesthesia over general anesthesia, respectively (p < 0.05). 11,993 patients who received neuraxial anesthesia were propensity matched to 23,946 patients who received general anesthesia. Propensity-matched logistic regressions found that neuraxial anesthesia was associated with decreased length of stay, 30-day severe adverse events, and acute rehab/skilled nursing facility discharge for White patients (p < 0.05 for all), but only decreased length of stay in Black and Hispanic patients (p = 0.01 and p = 0.02, respectively). Conclusions: Notable disparities exist in the administration of neuraxial anesthesia for isolated hip and femoral shaft fracture patients. Hispanic and Black race/ethnicity in particular influences provision of neuraxial anesthesia. Further research is required to understand the degree of effect modification and root causes of regional anesthesia access and benefits for this high-volume patient population.
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Affiliation(s)
- Daniel Qian
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.Q.)
| | - Ezekiel Olumuyide
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.Q.)
| | - Aakash Keswani
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (C.H.P.)
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY 10065, USA
| | - Hung-Mo Lin
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (C.H.P.)
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT 06510, USA
| | - Yuxia Ouyang
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (C.H.P.)
| | - Samuel DeMaria
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (C.H.P.)
| | - Jashvant Poeran
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY 10021, USA
| | - Chang H. Park
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (C.H.P.)
| | - Garrett W. Burnett
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.Q.)
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (C.H.P.)
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Khatib Y, Bal G, Liu R, Ashaia W, Sorial R. A randomised controlled trial assessing the effect of tranexamic acid on post-operative blood transfusions in patient with intra-capsular hip fractures treated with hemi- or total hip arthroplasty. Arch Orthop Trauma Surg 2024; 144:3095-3102. [PMID: 38847833 DOI: 10.1007/s00402-024-05325-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/12/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND Intravenous tranexamic acid (TA) has proven efficacy in reducing blood loss and incidence of transfusion of blood products in elective total joint arthroplasty. However, evidence of efficacy in the setting of intracapsular hip fractures needing hip hemiarthroplasty (HA) or total hip arthroplasty (THA) are scarce. This study aimed to assess post-operative transfusion incidence in this clinical setting. METHODS Over a five-year period 250 patients with intracapsular neck of femur fractures requiring arthroplasty were randomised to two groups. The treatment group received three-dose intravenous TA protocol and the control group received usual treatment without administration of TA. Blood loss was estimated from the change in Hb levels on day 1, 3 and 5 after surgery compared to preoperative levels. Transfusions of blood products were recorded when they were triggered by an a priori protocol. Post-operative complications were recorded during patient hospital admission. RESULTS The intervention group showed significantly lower transfusion incidence of packed red blood cells (PRBC) (6 vs. 15, p = 0.04, OR = 0.37, 95%CI OR = 0.14 to 0.99) and in the group of patients who received a blood transfusion, a trend was observed for patients who received TA to have lesser number of units of PRBC (mean = 1.3 vs. 1.6, p = 0.51). A significant difference was noted in post-operative Hb levels of day 1,3 and 5. Backward stepwise multivariable regression analysis showed the use of TA was the most significant factor for reduction in postoperative blood transfusion (p = 0.047, OR = 0.37, 95% CI OR = 0.14 to 0.99). Assessment of the strength of the correlation showed modest correlation (Pearson correlation - 0.13 p = 0.04, 95% CI correlation= -0.25 to -0.01). There was no increase in adverse events in patients who received TA. CONCLUSION The use of TA in setting of intracapsular hip fractures requiring arthroplasty reduces blood loss, the need for transfusion of blood products and may reduce surgical site complications without increasing the risk of VTE.
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Affiliation(s)
- Yasser Khatib
- Nepean Hospital, The School of Medicine Nepean, The University of Sydney, PO Box 949, Penrith, NSW, 2750, Australia.
| | - Gobind Bal
- Nepean Hospital, Derby St, Kingswood, NSW, 2747, Australia
| | - Rui Liu
- Nepean Hospital, Kingswood, NSW, Australia
| | - Wagdy Ashaia
- Nepean Hospital, Derby St, Kingswood, NSW, 2747, Australia
| | - Rami Sorial
- Nepean Hospital, The School of Medicine Nepean, The University of Sydney, PO Box 949, Penrith, NSW, 2750, Australia
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Hanson TM, Magder LS, Pellegrini VD. Substantial Improvement in Self-Reported Mental Health Following Total Hip Arthroplasty Occurs Independent of Anesthetic Technique. J Arthroplasty 2024; 39:1220-1225.e1. [PMID: 37977307 DOI: 10.1016/j.arth.2023.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 11/01/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND The influence of anesthetic type on mental health after total hip arthroplasty (THA) is poorly understood. Adverse effects of general anesthesia (GA) on cognition following major non-cardiac surgery are well known, but mental health following THA is less well-studied. We hypothesized that neuraxial anesthesia (NA) would provide favorable mental health profiles compared with GA after THA. METHODS Prospectively collected Patient-Reported Outcomes Measurement Information System-10 (PROMIS) Global Mental Health (GMH) scores at preoperative baseline, and 1, 3, and 6 months after THA were accessed on 4,353 patients in the Pulmonary Embolism Prevention After HiP and KneE Replacement (PEPPER) Trial (ClinicalTrials.gov: NCT02810704). Anesthesia was categorized as: general (GA), neuraxial (NA), and neuraxial with peripheral block (NAP). The GMH was assessed longitudinally and compared between groups. RESULTS Postoperative GMH improved (P < .05) over preoperative in every anesthetic group. Groups receiving NA had higher baseline GMH scores. Improvement in GMH was diminished after GA alone and plateaued after 1 month. Adding NA or peripheral nerve block to GA conferred additional benefit to GMH improvement. CONCLUSIONS Patient-perceived mental health improves significantly after THA regardless of anesthetic type. Patients who have higher baseline GMH scores more commonly received NA, likely due to nonsurgical care determinants; these differences in mental wellness persisted at follow-up. Adjunctive NA or peripheral nerve block favored GMH improvement, whereas solitary GA diminished GMH improvement, which plateaued after 1 month. Substantial mental health benefits of THA may overshadow subtle differences in GMH attributable to anesthetic type.
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Affiliation(s)
- Thomas M Hanson
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center and Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Laurence S Magder
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Vincent D Pellegrini
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center and Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
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Li G, Ma Q, Li Y, Tan F, Li X, Chen J. Effects of general and spinal anesthesia on postoperative rehabilitation in older adults after lower limb surgery: a retrospective cohort study. Front Med (Lausanne) 2024; 11:1386797. [PMID: 38606152 PMCID: PMC11007150 DOI: 10.3389/fmed.2024.1386797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 03/18/2024] [Indexed: 04/13/2024] Open
Abstract
Objective To investigate the effects of perioperative general anesthesia (GA) and spinal anesthesia (SA) on postoperative rehabilitation in elderly patients with lower limb surgery. Methods This retrospective propensity score-matched cohort study included patients aged 65 years or older who underwent lower limb surgery between January 1, 2020, and May 31, 2023. The GA and SA were selected at the request of the orthopedic surgeon, patient, and their family members. The main outcomes included the incidence of the patient's inability to self-care at discharge, postoperative complications including pulmonary infection, thrombus of lower extremity veins, infection of incisional wound and delirium, length of hospital stay, and incidence of severe pain in the first 2 days postoperatively. Results In total, 697 patients met the inclusion criteria, and 456 were included in the final analysis after propensity score matching. In the GA and SA groups, 27 (11.84%) and 26 (11.40%) patients, respectively, could not care for themselves at discharge. The incidence rates did not differ between the groups (p = 0.884). In contrast, the incidence of postoperative complications (GA: 10.53% and SA: 4.39%; p = 0.013) and the length of hospital stay (GA: 16.92 ± 10.65 days and SA: 12.75 ± 9.15 days; p < 0.001) significantly differed between the groups. Conclusion The choice of anesthesia is independent of the loss of postoperative self-care ability in older patients (>65 years) and is not a key factor affecting postoperative rehabilitation after lower limb surgery. However, compared with GA, SA reduces the incidence of postoperative complications and a prolonged hospital stay. Thus, SA as the primary anesthetic method is a protective factor against a prolonged hospital stay.
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Affiliation(s)
- Guifei Li
- Department of Anesthesiology, Shapingba District Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Qingjing Ma
- Department of Anesthesiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yizhen Li
- Department of Anesthesiology, Shapingba District Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Furong Tan
- Department of Anesthesiology, Shapingba District Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Xuan Li
- Department of Anesthesiology, Shapingba District Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Jie Chen
- Department of Anesthesiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Yamamoto S, Takegami Y, Tokutake K, Nakashima R, Naito K, Ogura K, Kato D, Imagama S. Effect of anaesthesia on cemented hemiarthroplasty -A multicentre retrospective study (TRON study). J Orthop Sci 2024; 29:585-588. [PMID: 36822946 DOI: 10.1016/j.jos.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/30/2023] [Accepted: 02/07/2023] [Indexed: 02/25/2023]
Abstract
INTRODUCTION This study aimed to investigate the survival rate, postoperative complications, and walking ability in cemented hemiarthroplasty (HA) for displaced femoral neck fractures according to the anaesthesia method. METHODS We conducted a retrospective study of a multicentre group (the TRON group). Three hundred fifty-eight patients who underwent cemented HA between 2015 and 2019 were selected; 289 patients of ≥75 years of age with no missing data were included. Patient background factors were matched and patients were assigned to spinal anaesthesia (SA) and general anaesthesia (GA) groups. The primary outcome was death at any time during the follow-up period. Secondary outcomes included postoperative complications and walking ability assessed using the Parker mobility score (PMS). Overall survival was evaluated using the Kaplan-Meier method, and differences were compared using the log-rank test. The incidence of each complication and PMS were compared between the two groups using Fisher's exact test. RESULTS Overall survival during follow-up was significantly higher in the SA group in comparison to the GA group (p = 0.037). In the SA and GA groups, the survival rate at 3 months postoperatively was 98.4% and 95.5%, respectively. The incidence of postoperative pneumonia was significantly higher in the GA (p = 0.012), and PMS at 3 months postoperatively was significantly higher in the SA group (p = 0.016). CONCLUSION The survival rate of elderly patients who underwent cemented HA was better in the SA group. General anaesthesia in cemented HA may be associated with lower life expectancy, increased incidence of pneumonia, and decreased walking ability.
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Affiliation(s)
- Shigeto Yamamoto
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiko Takegami
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Katsuhiro Tokutake
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ryo Nakashima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenta Naito
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Keisuke Ogura
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Daizo Kato
- Department of Orhopedic Surgery, Okazaki City Hospital, Okazaki, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Yang G, Cui G, Liu Y, Guo J, Yue C. O-POSSUM and P-POSSUM as predictors of morbidity and mortality in older patients after hip fracture surgery: a meta-analysis. Arch Orthop Trauma Surg 2023; 143:6837-6847. [PMID: 37162574 DOI: 10.1007/s00402-023-04897-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 04/13/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND The POSSUM model has been widely used to predict morbidity and mortality after general surgery. Modified versions known as O-POSSUM and P-POSSUM have been used extensively in orthopedic surgery, but their accuracy is unclear. This systematic review evaluated the predictive value of these models in older patients with hip fractures. METHODS This study was performed and reported based on the "Preferred reporting items for systematic reviews and meta-analyses" guidelines. PubMed, Cochrane, EMBASE, and Web of Science were comprehensively searched for relevant studies, whose methodological quality was evaluated according to the "Methodological index for non-randomized studies" scale. Revman 5 was used to calculate weighted ratios of observed to expected morbidity or mortality. RESULTS The meta-analysis included 10 studies, of which nine (2549 patients) assessed the ability of O-POSSUM to predict postoperative morbidity, nine (3649 patients) assessed the ability of O-POSSUM to predict postoperative mortality, and four (1794 patients) assessed the ability of P-POSSUM to predict postoperative mortality. The corresponding weighted ratios of observed to expected morbidity or mortality were 0.84 (95% CI 0.70-1.00), 0.68 (95% CI 0.49-0.95), and 0.61 (95% CI 0.16-2.38). CONCLUSIONS While O-POSSUM shows reasonable accuracy in predicting postoperative morbidity in older patients with hip fractures, both P-POSSUM and O-POSSUM substantially overestimate postoperative mortality. The POSSUM model should be optimized further for this patient population.
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Affiliation(s)
- Guangyao Yang
- Department of Orthopedic, Luoyang Orthopedic Hospital of Henan Province. Orthopedic Hospital of Henan Province, Luoyang, 471000, Henan Province, People's Republic of China
| | - Guofeng Cui
- Department of Orthopedic, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, 471002, Henan Province, People's Republic of China
| | - Youwen Liu
- Department of Orthopedic, Luoyang Orthopedic Hospital of Henan Province. Orthopedic Hospital of Henan Province, Luoyang, 471000, Henan Province, People's Republic of China
| | - Jiayi Guo
- Department of Orthopedic, Luoyang Orthopedic Hospital of Henan Province. Orthopedic Hospital of Henan Province, Luoyang, 471000, Henan Province, People's Republic of China
| | - Chen Yue
- Department of Orthopedic, Luoyang Orthopedic Hospital of Henan Province. Orthopedic Hospital of Henan Province, Luoyang, 471000, Henan Province, People's Republic of China.
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Chowdary AR, Beale J, Martinez J, Aggarwal V, Mounasamy V, Sambandam S. Postoperative complications of spinal vs general anesthesia in elderly patients undergoing hip hemiarthroplasty. Arch Orthop Trauma Surg 2023; 143:5615-5621. [PMID: 37061659 DOI: 10.1007/s00402-023-04876-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/03/2023] [Indexed: 04/17/2023]
Abstract
INTRODUCTION Elderly patients with hip fractures are at high risk for mortality due to postsurgical complications. Hip hemiarthroplasty is a routine procedure done in elderly patients for surgical repair of femoral neck fractures. Both general and spinal anesthesia can be used in elderly patients undergoing hemiarthroplasty. Rates of postoperative complications among the two anesthetic choices have not been directly compared. In this study, we compare the rates of postoperative complications in elderly patients (age greater than 70) undergoing hip hemiarthroplasty for femoral neck fractures using a national database. METHODS Data for the years 2015-2020 from the National Surgical Quality Improvement Program (NSQIP) were used for the study. Patients greater than 70 years of age who received a hip hemiarthroplasty with general anesthesia or spinal anesthesia were identified using CPT procedure codes. Pertinent preoperative variables and rates of postoperative complications were characterized and analyzed. RESULTS Our study found that elderly patients who received spinal anesthesia had, on average, longer length of stays but shorter operative times compared to patients who received general anesthesia. Furthermore, we found that patients who received spinal anesthesia had lower rates of systemic sepsis, cardiac arrests, and blood transfusions when compared to patients who received general anesthesia. Finally, we found that overall rates of mortality were significantly lower in the spinal anesthesia cohort compared to the general anesthesia cohort. CONCLUSION Our work suggests that patients who underwent spinal anesthesia for hip arthroplasty may have lower rates of postoperative complications. This work further highlights the role of anesthetic choice in preventing complications following hip hemiarthroplasty procedures.
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Affiliation(s)
| | - Jack Beale
- Department of Orthopedics, University of Texas Southwestern, Dallas, TX, USA
| | - Jack Martinez
- Department of Orthopedics, University of Texas Southwestern, Dallas, TX, USA
| | - Vikram Aggarwal
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Varatharaj Mounasamy
- Department of Orthopedics, University of Texas Southwestern, Dallas, TX, USA
- Department of Orthopedics, Dallas VA Medical Center, Dallas, TX, USA
| | - Senthil Sambandam
- Department of Orthopedics, University of Texas Southwestern, Dallas, TX, USA.
- Department of Orthopedics, Dallas VA Medical Center, Dallas, TX, USA.
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Schaar AN, Finneran JJ, Gabriel RA. Association of race and receipt of regional anesthesia for hip fracture surgery. Reg Anesth Pain Med 2023; 48:392-398. [PMID: 36737100 DOI: 10.1136/rapm-2022-104055] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 01/21/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND There is evidence suggesting clinical benefits of regional anesthesia use in the setting of hip fracture repair, including reduced risk of death, deep vein thrombosis, pulmonary complications and myocardial infarction. Thought the literature is mixed, the use of regional anesthesia in hip fracture surgery has not been studied for racial differences. We examined the association of race with neuraxial anesthesia and regional blocks in patients undergoing hip fracture surgery. METHODS Using American College of Surgeons National Surgical Quality Improvement Program, we identified patients ≥18 years old who were either white, black or Asian and underwent hip fracture surgery from 2014 to 2020. We reported unadjusted estimates of both regional and neuraxial anesthesia use by race and examined sociodemographic characteristics and health status differences. Two separate multivariable logistic regression models were employed to investigate the association of race with the receipt of (1) neuraxial anesthesia and (2) regional block (ie, peripheral nerve blocks, fascial plane blocks). RESULTS There were 104,949 patients who underwent hip fracture surgery, of whom 16,400 (15.6%) received a neuraxial anesthetic and 6264 (5.9%) received a regional block. On multivariable logistic regression analysis, compared with white patients, black patients (OR 0.67, 99% CI 0.59 to 0.75, p<0.001) had decreased odds, while Asian patients (OR 2.04, 99% CI 1.84 to 2.26, p<0.001) had increased odds for receipt of neuraxial anesthesia as a primary anesthetic. Black race (OR 1.35, 99% CI 1.17 to 1.55, p<0.001) was associated with increased odds for receiving a regional block compared with white patients. CONCLUSIONS The study suggests that racial differences exist with the utilization of regional anesthesia for hip fracture surgery. While the results of this study should not be taken as evidence for healthcare disparities, it could be used to support hypotheses for future studies that aim to investigate causes of disparities and corresponding patient outcomes.
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Affiliation(s)
- Adam N Schaar
- Anesthesiology, University of California Health Sciences, La Jolla, California, USA
| | - John J Finneran
- Department of Anesthesiology, University of California, San Diego, California, USA
| | - Rodney A Gabriel
- Anesthesiology, University of California, La Jolla, California, USA
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11
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Ma B, Xie H, Ling H, Ma W. Perioperative outcomes in different anesthesia techniques for patients undergoing hip fracture surgery: a systematic review and meta-analysis. BMC Anesthesiol 2023; 23:184. [PMID: 37237276 DOI: 10.1186/s12871-023-02150-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 05/24/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Previous studies of the perioperative effects of general and regional anesthesia in adult patients undergoing effects of different anesthesia techniques on patients undergoing hip fracture surgery have not produced consistent results. The aim of this systematic review and meta-analysis was to compare the hip fracture surgery. METHODS We performed a systematic review and meta-analysis to compare the effects of general anesthesia with regional anesthesia on in-hospital mortality, 30-day mortality, postoperative pneumonia, and delirium in adult hip fracture patients (≥ 18 years). Between January 1, 2022, and March 31, 2023, a systematic search was performed for retrospective observational and prospective randomized controlled studies in PubMed, Ovid Medline, Cochrane Library, and Scopus. RESULTS Twenty-one studies including 363,470 patients showed higher in-hospital mortality in the general anesthesia group compared with regional anesthesia (OR = 1.21; 95% CI 1.13-1.29; P < 0.001, n = 191,511). The 30-day mortality (OR = 1.00; 95% CI 0.96-1.05; P = 0.95, n = 163,811), the incidence of postoperative pneumonia (OR = 0.93; 95% CI 0.82-1.06; P = 0.28, n = 36,743) and the occurrence of postoperative delirium in the two groups (OR = 0.94; 95% CI 0.74-1.20; P = 0.61, n = 2861) had no significant difference. CONCLUSION Regional anesthesia is associated with reduced in-hospital mortality. However, the type of anesthesia did not affect the occurrence of 30-day mortality, postoperative pneumonia, and delirium. A large number of randomized studies are needed in the future to examine the relationship between type of anesthesia, postoperative complications, and mortality.
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Affiliation(s)
- Bo Ma
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, People's Republic of China
| | - Haibiao Xie
- Department of Urology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, People's Republic of China
| | - Huayong Ling
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, People's Republic of China
| | - Wuhua Ma
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, People's Republic of China.
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12
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White SM, Tedore T, Shelton CL. There is (probably) no (meaningful) difference in (most) outcomes between 'spinal' and 'general' anaesthesia for hip fracture surgery: time to move forward. Br J Anaesth 2023; 130:385-389. [PMID: 36801101 DOI: 10.1016/j.bja.2023.01.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/12/2023] [Accepted: 01/14/2023] [Indexed: 02/18/2023] Open
Abstract
A meta-analysis influenced by two recent large randomised controlled trials (REGAIN and RAGA) concluded that little, if any, difference in commonly measured outcomes exists between patients administered spinal or general anaesthesia for their hip fracture surgery. We explore whether there is genuinely no difference, or what the methodological problems in research might be that prevent any real difference from being observed. We also discuss the need for greater nuance in future research to determine how anaesthetists might deliver perioperative care towards improving postoperative recovery trajectories in patients following hip fracture.
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Affiliation(s)
- Stuart M White
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK.
| | - Tiffany Tedore
- Weill Cornell Medical College, NewYork-Presbyterian Hospital/Weill Cornell, New York, NY, USA
| | - Clifford L Shelton
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK; Lancaster Medical School, Lancaster University, Lancaster, UK
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13
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Perlman R, Bonge S. Regional anesthesia in trauma patients: a quality improvement study. Eur J Trauma Emerg Surg 2023; 49:495-504. [PMID: 36057887 DOI: 10.1007/s00068-022-02097-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/23/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Traumatic injury is associated with severe pain that is often inadequately managed. Opioids remain the mainstay of pain management in this population because of their ease of use. However, opioids have significant side effects including nausea, delirium, and respiratory depression. Regional anesthesia has been demonstrated in the perioperative setting to provide superior analgesia with fewer side effects and a reduced length of stay. Similarly, regional anesthesia has been shown to improve morbidity for extremity fractures and dislocations when introduced early. METHODS This was a prospective cohort quality improvement study evaluating the use of earlier and more consistent regional anesthesia procedures in 28 consecutive trauma patients at a large Canadian trauma center. In this quasi-experimental before and after study, we identified all trauma patients with an ISS < 15 that would have been candidates for a peripheral nerve block and compared them to the study population that received a regional anesthesia nerve block within 24 h of admission. RESULTS The introduction of a multidisciplinary pain program into our level 1 regional trauma center resulted in a decrease in pain severity and opioid consumption of 55% and 61%, respectively, after 24 h of admission. Length of stay in the emergency department decreased (11.5 ± 6.9 vs. 4.9 ± 4.4 h; p < 0.01) while hospital length of stay did not (338 ± 276 vs. 285 ± 205 h; p = 0.4). CONCLUSION This quality improvement proof-of-principle study reveals the potential advantages for regional anesthesia, such as decreased emergency department use, opioid consumption, and pain severity. Further randomized trials are necessary, however, to describe a direct benefit from peripheral nerve blockade on reducing length of stay for trauma patients.
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Affiliation(s)
- Ryan Perlman
- Division of Trauma Anesthesia, Cedars-Sinai Medical Center, 8700 Beverly Blvd., North Tower, Suite 8211, Los Angeles, CA, 90048, USA.
| | - Sam Bonge
- Cedars-Sinai Medical Center, 8700 Beverly Blvd., North Tower, Suite 8211, Los Angeles, CA, 90048, USA
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14
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Nawi SNM, Wong B, Edwards S, Loh X, Maddison J. A retrospective observational study on the types of anaesthesia in hip fracture surgery. J Perioper Pract 2023; 33:15-23. [PMID: 34197241 DOI: 10.1177/17504589211006020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND There is no specific recommendation regarding the type of anaesthesia in hip fracture surgery. OBJECTIVES This study sought to examine the current local anaesthetic practice (general anaesthesia versus regional anaesthesia (RA)) in hip fracture surgery and to analyse their associations with perioperative outcomes. METHODOLOGY A retrospective observational study of hip fracture patients from April to December 2017 was undertaken. Patient characteristics and perioperative outcomes were analysed against the types of anaesthesia using multiple logistic regression. RESULTS One hundred and twelve out of 154 patients (72.7%) had a general anaesthesia. Patients from residential care facilities were more likely to receive general anaesthesia (OR = 2.9, 95% CI: 1.1, 7.4; P = 0.03). There was no significant association between type of anaesthesia and specific postoperative outcomes; however, patients with postoperative delirium and hypotension were more likely to have received general anaesthesia [OR = 1.7, 95% CI: 0.68, 4.38; P = 0.25] and [OR = 1.6, 95% CI: 0.67, 4.04; P = 0.27] respectively). Subgroup analysis showed increased length of stay with patients who underwent general anaesthesia (OR = 1.26, 95% CI:1.04, 1.54; P = 0.02). CONCLUSION Regional anaesthesia may be considered in patients without contraindications in view of increased risk of postoperative delirium and hypotension, and longer length of stay with general anaesthesia. A larger prospective study is needed to confirm these findings.
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Affiliation(s)
- Siti N Mohd Nawi
- Geriatric Medicine Department, Northern Adelaide Local Health Network, Modbury Hospital, Modbury, Australia.,Hospital Universiti Sains Malaysia and School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Bianca Wong
- Geriatric Medicine Department, Northern Adelaide Local Health Network, Modbury Hospital, Modbury, Australia.,Orthogeriatric Service, Northern Adelaide Local Health Network, Lyell McEwin Hospital, Elizabeth Vale, Australia
| | - Suzanne Edwards
- Data, Design and Statistics Service, Adelaide Health Technology Assessment (AHTA), School of Public Health, The University of Adelaide, Adelaide, Australia
| | - Xiang Loh
- Geriatric Medicine Department, Northern Adelaide Local Health Network, Modbury Hospital, Modbury, Australia.,Orthogeriatric Service, Northern Adelaide Local Health Network, Lyell McEwin Hospital, Elizabeth Vale, Australia
| | - John Maddison
- Geriatric Medicine Department, Northern Adelaide Local Health Network, Modbury Hospital, Modbury, Australia.,Orthogeriatric Service, Northern Adelaide Local Health Network, Lyell McEwin Hospital, Elizabeth Vale, Australia
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15
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Zhang G, Chen H, Zha J, Zhang J, Di J, Wang X, Hu X, Xu X, Guo J. Effect of General vs. Regional Anesthesia on Mortality, Complications, and Prognosis in Older Adults Undergoing Hip Fracture Surgery: A Propensity-Score-Matched Cohort Analysis. J Clin Med 2022; 12:jcm12010080. [PMID: 36614881 PMCID: PMC9821019 DOI: 10.3390/jcm12010080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 10/23/2022] [Accepted: 11/14/2022] [Indexed: 12/24/2022] Open
Abstract
The choice of the type of anesthesia (TOA) used in hip fracture surgery in older adults is still controversial. The main question is not whether regional anesthesia (RA) or general anesthesia (GA) is superior, but in which patients the type of anesthesia may affect the outcome after surgery. In this retrospective analysis of surgically treated intertrochanteric fracture patients, we used propensity score matching (PSM) to investigate whether clinically relevant differences in outcomes were observed in mortality, complications, and functional outcomes between RA and GA. After screening 2934 consecutive patients, 2170 were ultimately included, including 841 in the GA group and 1329 in the RA group. After PSM, 808 remained in each group. Patients receiving GA were more prone to have a shorter duration for their operation and higher total hospital costs than patients with RA (p = 0.034 and 0.004, respectively). We also observed that the GA group has a higher rate of pulmonary complications, while the RA group has a higher rate of cardiac complications (p = 0.017 and 0.011, respectively). No significant difference was observed in mortality, functional outcomes, and other complications (all p > 0.05). The clinical innovation of this study was the potential value of GA for patients with cardiac diseases and of RA for patients with pulmonary diseases.
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Affiliation(s)
- Guolei Zhang
- Department of Orthopaedics Surgery, Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
- Orthopaedic Institute of Hebei Province, Shijiazhuang 050051, China
| | - Huihui Chen
- Department of Nephrology, Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China
| | - Junpu Zha
- Department of Orthopaedics Surgery, Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
- Orthopaedic Institute of Hebei Province, Shijiazhuang 050051, China
| | - Jingtao Zhang
- Department of Orthopaedics Surgery, Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
- Orthopaedic Institute of Hebei Province, Shijiazhuang 050051, China
| | - Jun Di
- Department of Orthopaedics Surgery, Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
- Orthopaedic Institute of Hebei Province, Shijiazhuang 050051, China
| | - Xiaoqing Wang
- Department of Orthopaedics Surgery, Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
| | - Xin Hu
- Department of Orthopaedics Surgery, Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
- Orthopaedic Institute of Hebei Province, Shijiazhuang 050051, China
| | - Xin Xu
- Department of Biochemistry and Molecular Biology, College of Basic Medicine, Hebei Medical University, Shijiazhuang 050011, China
- Key Laboratory of Neural and Vascular Biology of Ministry of Education, Shijiazhuang 050011, China
- Key Laboratory of Medical Biotechnology of Hebei Province, Hebei Medical University, Shijiazhuang 050011, China
- Correspondence: (X.X.); (J.G.)
| | - Junfei Guo
- Department of Orthopaedics Surgery, Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
- Orthopaedic Institute of Hebei Province, Shijiazhuang 050051, China
- Correspondence: (X.X.); (J.G.)
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16
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Kunutsor SK, Hamal PB, Tomassini S, Yeung J, Whitehouse MR, Matharu GS. Clinical effectiveness and safety of spinal anaesthesia compared with general anaesthesia in patients undergoing hip fracture surgery using a consensus-based core outcome set and patient-and public-informed outcomes: a systematic review and meta-analysis of randomised controlled trials. Br J Anaesth 2022; 129:788-800. [PMID: 36270701 PMCID: PMC9642835 DOI: 10.1016/j.bja.2022.07.031] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/13/2022] [Accepted: 07/15/2022] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND We conducted a systematic review and meta-analysis of contemporary RCTs to determine the clinical effectiveness of spinal vs general anaesthesia (SA vs GA) in patients undergoing hip fracture surgery using a consensus-based core outcome set, and outcomes defined as important by patient and public involvement (PPI) initiatives. METHODS RCTs comparing any of the core outcomes (mortality, time from injury to surgery, acute coronary syndrome, hypotension, acute kidney injury, delirium, pneumonia, orthogeriatric input, being out of bed at day 1 postoperatively, and pain) or PPI-defined outcomes (return to preoperative residence, quality of life, and mobility status) between SA and GA were identified from MEDLINE, Embase, Cochrane Library, and Web of Science (2000 to February 2022). Pooled relative risks (RRs) and mean differences (95% confidence intervals [CIs]) were estimated. RESULTS There was no significant difference in the risk of delirium comparing SA vs GA (RR=1.07; 95% CI, 0.90-1.29). Comparing SA vs GA, the RR for mortality was 0.56 (95% CI, 0.22-1.44) in-hospital, 1.07 (95% CI, 0.52-2.23) at 30 days, and 1.08 (95% CI, 0.55-2.12) at 90 days. Spinal anaesthesia reduced the risk of acute kidney injury compared with GA: RR=0.59 (95% CI, 0.39-0.89). There were no significant differences in the risk of other outcomes. Few studies reported PPI-defined outcomes, with most studies reporting on one to three core outcomes. CONCLUSIONS Except for acute kidney injury, there were no differences between SA and GA in hip fracture surgery when using a consensus-based core outcome set and patient and public involvement-defined outcomes. Most studies reported limited outcomes from the core outcome set, and few reported outcomes important to patients, which should be considered when designing future RCTs. PROSPERO REGISTRATION CRD42021275206.
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Affiliation(s)
- Setor K Kunutsor
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK; Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Bristol, UK
| | - Pravakar B Hamal
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Bristol, UK
| | - Sara Tomassini
- Warwick Clinical Trials Unit, University of Warwick, Warwick, UK
| | - Joyce Yeung
- Warwick Clinical Trials Unit, University of Warwick, Warwick, UK; University Hospitals of Birmingham NHS Foundation Trust, Birmingham, UK
| | - Michael R Whitehouse
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK; Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Bristol, UK
| | - Gulraj S Matharu
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Bristol, UK.
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17
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Lin DY, Woodman R, Oberai T, Brown B, Morrison C, Kroon H, Jaarsma R. Association of anesthesia and analgesia with long-term mortality after hip fracture surgery: an analysis of the Australian and New Zealand hip fracture registry. Reg Anesth Pain Med 2022; 48:14-21. [DOI: 10.1136/rapm-2022-103550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 09/13/2022] [Indexed: 11/04/2022]
Abstract
IntroductionHip fractures are a common frailty injury affecting a vulnerable geriatric population. It is debated if anesthetic and analgesic techniques are associated with altered risk for outcomes in hip fracture patients. This study aimed to determine the association of anesthesia and regional analgesia with all cause 12-month mortality and even longer-term mortality after hip fracture surgery in Australia and New Zealand.MethodsData from the Australian and New Zealand Hip Fracture Registry collected from 2016 to 2018, with a minimum follow-up of 12 months, were reviewed. Anesthesia type and use of regional nerve blocks were investigated. The primary outcome was all cause 12-month mortality.Results12-month mortality was 30.6% (n=5410) in a total of 17,635 patients. There was no difference in 12-month mortality between patients who received spinal or general anesthesia (p=0.238). The administration of a combination of general and spinal anesthesia for surgery to repair the fracture was an independent predictor of higher 12-month mortality (unadjusted complete case HR=1.17 (95% CI 1.04 to 1.31); p<0.001). Nerve blocks performed in both the emergency department (ED) and the operating theater (OT) were associated with reduced long-term mortality (median follow-up 21 months) with an unimputed unadjusted HR=0.86 (95% CI 0.77 to 0.96; p=0.043).ConclusionThere was no difference in the association of 12-month mortality between general and spinal anesthesia in patients undergoing hip fracture surgery. However, there was an association with a higher risk of 12-month mortality in patients who received both general and spinal anesthesia for the same surgery. Patients who received a regional nerve block in both the ED and the OT had a lower association of 12-month and longer-term mortality risk. The reasons for these findings remain unknown and should be the subject of further research investigation.
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18
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Leibold C, Falbo R, Gupta A, Miller R, Pederson JM, Malpe M. A systematic review and meta-analysis of anesthesia type on hip fracture post-surgery outcomes. OTA Int 2022; 5:e204. [PMID: 36425088 PMCID: PMC9580260 DOI: 10.1097/oi9.0000000000000204] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 03/15/2022] [Indexed: 11/30/2022]
Abstract
Objective To compare technical, clinical, and safety outcomes among hip fracture patients treated with procedures supplemented by general anesthesia (GA) or spinal/regional anesthesia (S/R). Data sources We searched for original studies on PubMed, Ovid MEDLINE, Ovid Embase, and Cochrane databases. Study selection Studies that reported clinical outcomes in patients that underwent hip fracture surgery, had available data on type of anesthesia administered, and clinical follow-up data were selected for data extraction. Data extraction The primary outcomes of interest were odds of mortality, including in-hospital, 30-day, 90-day, and 1-year mortality. Various adverse events (AEs) were also compared. Data synthesis Twenty-eight studies met our selection criteria, including 190,394 patients. A total of 107,314 (56.4%) patients were treated with procedures involving GA while 83,080 (43.6%) were treated with procedures involving S/R. There was no difference in 30-day or >1-year mortality rates between the GA and SR groups; however, compared to S/R group, the GA group had a significantly higher odds of in-hospital (P = .004) and 90-day mortality (P = .004). There was no difference in odds of adverse events between the GA and the S/R group. Conclusions Patients administered S/R for hip fracture procedures demonstrate lower risk of in-hospital mortality and 90-day mortality compared to patients administered GA. Level of evidence Therapeutic level III.
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Affiliation(s)
| | - Ryan Falbo
- Department of Orthopedic Surgery, Mercy Health St. Vincent Medical Center
| | | | - Richard Miller
- Department of Orthopedic Surgery, Mercy Health St. Vincent Medical Center
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19
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URAL SG, GOKALP F, KARAZİNDİYANĞLU S, TÖR İH. Comparison of the effects of general and regional anesthesia applications on postoperative life quality in elderly patients with transurethral prostate resection. MUSTAFA KEMAL ÜNIVERSITESI TIP DERGISI 2022. [DOI: 10.17944/mkutfd.1025384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE: Our study aimed to investigate changes in patient satisfaction and quality of life according to the anesthesia method applied for transurethral resection of the prostate (TUR-P) due to benign prostatic hypertrophy in geriatric patients with lower urinary system symptoms.
METHODS: A total of 60 patients scheduled for TUR-P were included in the study. The patients were divided into two groups as those receiving spinal anesthesia and those receiving general anesthesia. We recorded demographic data and preoperative and perioperative parameters. We evaluated the postoperative quality of life and satisfaction of the patients using the Short Form-36 scale.
RESULTS: There was no statistically significant difference between the two groups in terms of demographic data and hemodynamic changes. There was a higher rate of patients who consumed alcohol and smoked in the general anesthesia group (p0.005). The scores in the physical functioning (p
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20
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Goel CP, Desai S. Efficacy of dexmedetomidine as an adjuvant in femoral nerve block for post-op pain relief in hip surgery: A prospective randomized double-blind controlled study. J Anaesthesiol Clin Pharmacol 2021; 37:383-388. [PMID: 34759548 PMCID: PMC8562428 DOI: 10.4103/joacp.joacp_182_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 10/10/2019] [Accepted: 03/06/2020] [Indexed: 11/15/2022] Open
Abstract
Background and Aims: To determine whether the addition of dexmedetomidine either in peripheral block or via systemic route leads to prolongation of the duration of analgesia is inconclusive. The present study aimed to assess the duration of postoperative analgesia with dexmedetomidine used as an additive with bupivacaine for ultrasound-guided femoral nerve block (FNB) and to compare it with intramuscular dexmedetomidine along with FNB. Material and Methods: A prospective, double-blind randomized clinical trial involving adult patients undergoing elective hip surgery, performed under subarachnoid block. When sensory block receded to T12 after the surgery, FNB was given for postoperative analgesia. Patients were randomized into three groups; Group A received FNB with 40 mL 0.25% bupivacaine and 0.5 mL saline as IM injection, Group B received FNB with 39.5 mL of 0.25% bupivacaine + 0.5 mL (50 mcg) of dexmedetomidine in the affected limb and 0.5 mL saline IM injection, and Group C received FNB with 40 mL of 0.25% bupivacaine and 0.5 mL (50 mcg) of dexmedetomidine as IM injection. Postoperative pain was assessed and for pain with VAS score >3, intravenous tramadol was given as rescue analgesia. Chi-square test for categorical variables and one-way ANOVA for continuous variables. Results: The mean duration of analgesia in groups A, B, and C was 671, 676, and 490 min, respectively which was not significant. A 24 h analgesic requirement was also not different between the groups. Conclusion: The use of dexmedetomidine perineurally or systemically did not prolong the duration of analgesia as compared to bupivacaine alone for femoral nerve block.
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Affiliation(s)
- Chetna P Goel
- Department of Anesthesia, SDM College of Medical Sciences and Hospital, Sattur, Dharwad, Karnataka, India
| | - Sameer Desai
- Department of Anesthesia, SDM College of Medical Sciences and Hospital, Sattur, Dharwad, Karnataka, India
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21
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Radbin T, Kamali A, Yazdi B, Pazouki S, Hadi H, Rakei S. Efficacy of dexmedetomidine and ketamine addition to bupivacaine 0.25% by epidural method in reducing postoperative pain in patients undergoing femur fracture surgery. J Family Med Prim Care 2021; 10:832-837. [PMID: 34041085 PMCID: PMC8138368 DOI: 10.4103/jfmpc.jfmpc_1506_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/29/2020] [Accepted: 12/11/2020] [Indexed: 12/27/2022] Open
Abstract
Background and Aim: One of the most complex medical problems is pain, that due to inappropriate management of patients after surgery could cause various side effects on the psychological, physiological, and metabolic state of the patients. The natural duration of analgesia can be increased by adding new efficient adjuvant. The present study is mainly aimed to investigate the differences between the epidural dexmedetomidine and ketamine effectiveness when administered as an adjuvant to epidural 0.25% bupivacaine for improving the postoperative analgesia duration. Methods: In the present double-blind clinical study, 105 patients of the age range of 40–85 years were selected for elective femoral surgery and then was divided into three of ketamine, dexmedetomidine, and control randomly. The scores of postoperative pain were evaluated in accordance with the visual Analogue Scale (VAS) criteria and the duration of analgesia and the amount of analgesics consumption were recorded. Results: The mean pain VAS score during the first day after the surgery and recovery of patients in the dexmedetomidine group was significantly lower in comparison with two other groups (p = 0.01). However, no significant difference was found in the mean VAS score of Paine during 12 and 24 hours after the operation (P ≥ 0.05). Comparisons among these groups demonstrated that the mean on opioid administration during the operation and 24 hours after that was significantly higher in both groups of ketamine and control in comparison with the dexmedetomidine group (P = 0.001 and P = 0.01). Besides, analgesia duration among patients belonged to the dexmedetomidine group was notably lower in comparison with two other groups (P = 0.001). Conclusion: In epidural anesthesia cases adding ketamine and dexmedetomidine as adjuvants to the solution of bupivacaine 0.25%, could increase the duration of analgesia and reduce the consumption of analgesics, which is more in the dexmedetomidine group when compared with ketamine.
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Affiliation(s)
- Taraneh Radbin
- Department of Anesthesiology and Critical Care, Arak University of Medical Sciences, Arak, Iran
| | - Alireza Kamali
- Department of Anesthesiology and Critical Care, Arak University of Medical Sciences, Arak, Iran
| | - Bijan Yazdi
- Department of Anesthesiology and Critical Care, Arak University of Medical Sciences, Arak, Iran
| | - Shirin Pazouki
- Department of Anesthesiology and Critical Care, Arak University of Medical Sciences, Arak, Iran
| | - Hoseinali Hadi
- Department of Orthopedics, Arak University of Medical Sciences, Arak, Iran
| | - Siamak Rakei
- Department of Surgery, Arak University of Medical Sciences, Arak, Iran
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Garg V, Lawrence H, Joshi Y. Comparative outcome of anaesthetic for elderly hip fracture. J Clin Orthop Trauma 2021; 12:177-182. [PMID: 33716444 PMCID: PMC7920336 DOI: 10.1016/j.jcot.2020.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Current guidelines recommend offering patients both options of a spinal or general anaesthetic. At local level we attempt to ensure whether similar outcome is reflected in our practice regarding difference between General anaesthesia(GA) and Spinal Anaesthesia(SA) in morbidity and mortality. METHODS Data from spreadsheet maintained for NHFD was used to identify patients with Neck of Femur Fracture in 2018.Mortality data was retrieved from the Welsh Clinical Portal. Data was organised according to the type of anaesthetic received. Outcome measures for Morbidity (length of stay in hospital) and Mortality (at both 30 days and 120 days) following surgery, were then inputted for these patients. Statistical analysis was performed using SPSS software. A Mann Whitney U Test was performed for length of stay and Kaplan-Meier Estimates for survival at 30 and 120 days. Log Rank (Mantel Cox) Hypothesis Test is used to compare mortality between two Anaesthetic groups. RESULTS We reviewed 203 patients elderly hip fracture with mean age of 83 (range 60-99), there were 142 Female and 61 males.4 patients were treated non operatively, and 2 patients had no data available 0.146 patient received GA and 46 received spinal anaesthesia. Hemiarthroplasty and DHS are commonest procedure in both groups. On applying Mann Whitney U test There is no statistical difference between the length of stay There is no statistical difference between the length of stay for SA and GA Patients. (p = 0.483). for SA and GA Patients (p = 0.483). On APPLYING Log Rank (Mantel-Cox) Analysis there is no statically difference in mortality at 30 days and 120 days with p value 0.087 and 0.397 respectively. CONCLUSION In summary, this audit remains in line with current literature, that there is not a significant difference between the length of stay, survival at 30 days and at 120 days between the two different groups.
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Hansen J, Rasmussen LS, Steinmetz J. Management of Ambulatory Anesthesia in Older Adults. Drugs Aging 2020; 37:863-874. [PMID: 33073330 DOI: 10.1007/s40266-020-00803-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2020] [Indexed: 12/12/2022]
Abstract
The number of older patients is increasing globally. Combined with the growing number of ambulatory surgeries, many older patients will undergo ambulatory surgery in the future. The ambulatory setting offers many advantages: early mobilization, higher patient satisfaction, lower costs, and a low incidence of several complications such as infections and thromboembolic events. Moreover, cognitive recovery seems to be enhanced compared with in-hospital surgery, and both frail patients and patients with dementia can benefit from ambulatory surgery. This review provides suggestions for managing perioperative anesthesia for older patients in the ambulatory setting. Not all older patients are eligible for ambulatory surgery, and clinicians must be aware of risk factors for complications, especially frailty. Most anesthesia techniques and agents can be used in the ambulatory setting, but short-acting agents are preferred to ensure fast recovery. Both regional and general anesthesia are useful, but clinicians must be familiar with the physiological changes and specific implications in the older population. The older patients are more sensitive to anesthetic agents, meaning that a lower dose is needed to obtain the desired effect. However, they exhibit huge variation in pharmacodynamics and pharmacokinetics. Prolonged onset time may lead to overdosing and extended recovery. After surgery, effective pain management with opioid minimization is essential to ensure rapid recovery.
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Affiliation(s)
- Joachim Hansen
- Department of Anesthesia, Centre of Head and Orthopedics, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Lars Simon Rasmussen
- Department of Anesthesia, Centre of Head and Orthopedics, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Steinmetz
- Department of Anesthesia, Centre of Head and Orthopedics, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Aissa I, Wartiti LE, Bouhaba N, Khallikane S, Moutaoukil M, Kartite N, Elkoundi A, Benakrout A, Chlouchi A, Elbouti A, Najout H, Grine A, Touab R, Zaizi A, Youssef J, Bakkali H, Balkhi H, Bensghir M. [Combined lumbar plexus-sciatic nerve block in the emergency surgery for pertrochanteric fracture: an alternative technique in patients at high risk of anaesthetic complications]. Pan Afr Med J 2020; 37:12. [PMID: 33062115 PMCID: PMC7532854 DOI: 10.11604/pamj.2020.37.12.21392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 07/13/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction l’anesthésie pour la chirurgie urgente de la fracture pertrochantérienne (FPT) chez les patients à haut risque anesthésique représente souvent un véritable challenge pour les praticiens en vue du risque periopératoire majeur. Nous rapportons notre expérience avec le bibloc ou bloc combiné lombaire et sciatique plexique (BCLS) comme technique anesthésique alternative face à ce type de situation. Méthodes une étude transversale, descriptive, monocentrique, a été menée sur une période de 3 ans, incluant les patients à haut risque anesthésique présentant une FPT récente. Les deux blocs nerveux étaient réalisés au niveau plexique selon la technique classique de neurostimulation. Un mélange de 20ml de lidocaine 2% et de bupivacaine 0,5% (50/50) a été injecté au niveau de chaque bloc. Le critère d’évaluation principal était l’efficacité du BCLS apprécié par l’incidence d’échecs de la technique anesthésique, définie par la nécessité de convertir en anesthésie générale (AG). Les critères d’évaluation secondaires étaient: 1) les données techniques de la procédure anesthésique, 2) les retentissements hémodynamiques, respiratoires et neurologiques periopératoires, et 3) les résultats et les complications éventuelles en postopératoire. Résultats trente patients ont été colligés. L’âge moyen était de 74 ± 10 ans. Le délai moyen d’admission aux urgences-intervention était de 12(5-36) heures. La durée moyenne pour la réalisation de la procédure était de 15,20 ± 3,45 minutes. Aucune conversion en AG n’a été nécessaire. Il n’y avait pas de différences statistiquement significatives entre les différentes valeurs enregistrées des paramètres hémodynamiques et respiratoires periopératoires (PAM, FC, SpO2) (p > 0,05). La durée de l’intervention était de 46 ± 5 minutes. La satisfaction des chirurgiens était de 9,7 ± 0,1. La première demande en antalgiques postopératoires était après 8(1-24) heures. Tous les patients avaient une récupération sensitivomotrice complète. Conclusion le BCLS est une alternative anesthésique pour les interventions urgentes de FPT chez les patients à haut risque anesthésique: délais opératoires réduits, efficacité anesthésique, stabilité hémodynamique et respiratoire periopératoire, absence de complications inhérentes aux autres techniques anesthésiques, passage rapide en salle de surveillance post-interventionnelle (SSPI), et analgésie postopératoire de qualité.
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Affiliation(s)
- Ismail Aissa
- Pôle d'Anesthésie-Réanimation, Hôpital Militaire d'Instruction Mohamed V, Faculté de Médecine et de Pharmacie, Université Mohamed V, Rabat, Maroc
| | - Loukman El Wartiti
- Pôle d'Anesthésie-Réanimation, Hôpital Militaire d'Instruction Mohamed V, Faculté de Médecine et de Pharmacie, Université Mohamed V, Rabat, Maroc
| | - Najib Bouhaba
- Pôle d'Anesthésie-Réanimation, Hôpital Militaire d'Instruction Mohamed V, Faculté de Médecine et de Pharmacie, Université Mohamed V, Rabat, Maroc
| | - Said Khallikane
- Pôle d'Anesthésie-Réanimation, Hôpital Militaire d'Instruction Mohamed V, Faculté de Médecine et de Pharmacie, Université Mohamed V, Rabat, Maroc
| | - Mohamed Moutaoukil
- Pôle d'Anesthésie-Réanimation, Hôpital Militaire d'Instruction Mohamed V, Faculté de Médecine et de Pharmacie, Université Mohamed V, Rabat, Maroc
| | - Noureddine Kartite
- Pôle d'Anesthésie-Réanimation, Hôpital Militaire d'Instruction Mohamed V, Faculté de Médecine et de Pharmacie, Université Mohamed V, Rabat, Maroc
| | - Abdelghafour Elkoundi
- Pôle d'Anesthésie-Réanimation, Hôpital Militaire d'Instruction Mohamed V, Faculté de Médecine et de Pharmacie, Université Mohamed V, Rabat, Maroc
| | - Aziz Benakrout
- Pôle d'Anesthésie-Réanimation, Hôpital Militaire d'Instruction Mohamed V, Faculté de Médecine et de Pharmacie, Université Mohamed V, Rabat, Maroc
| | - Abdellatif Chlouchi
- Pôle d'Anesthésie-Réanimation, Hôpital Militaire d'Instruction Mohamed V, Faculté de Médecine et de Pharmacie, Université Mohamed V, Rabat, Maroc
| | - Anas Elbouti
- Pôle d'Anesthésie-Réanimation, Hôpital Militaire d'Instruction Mohamed V, Faculté de Médecine et de Pharmacie, Université Mohamed V, Rabat, Maroc
| | - Hamza Najout
- Pôle d'Anesthésie-Réanimation, Hôpital Militaire d'Instruction Mohamed V, Faculté de Médecine et de Pharmacie, Université Mohamed V, Rabat, Maroc
| | - Ali Grine
- Pôle d'Anesthésie-Réanimation, Hôpital Militaire d'Instruction Mohamed V, Faculté de Médecine et de Pharmacie, Université Mohamed V, Rabat, Maroc
| | - Reda Touab
- Pôle d'Anesthésie-Réanimation, Hôpital Militaire d'Instruction Mohamed V, Faculté de Médecine et de Pharmacie, Université Mohamed V, Rabat, Maroc
| | - Abderrahim Zaizi
- Service de Traumatologie Orthopédie, Hôpital Militaire d'Instruction Mohamed V, Faculté de Médecine et de Pharmacie, Université Mohamed V, Rabat, Maroc
| | - Jalal Youssef
- Service de Traumatologie Orthopédie, Hôpital Militaire d'Instruction Mohamed V, Faculté de Médecine et de Pharmacie, Université Mohamed V, Rabat, Maroc
| | - Hicham Bakkali
- Pôle d'Anesthésie-Réanimation, Hôpital Militaire d'Instruction Mohamed V, Faculté de Médecine et de Pharmacie, Université Mohamed V, Rabat, Maroc
| | - Hicham Balkhi
- Pôle d'Anesthésie-Réanimation, Hôpital Militaire d'Instruction Mohamed V, Faculté de Médecine et de Pharmacie, Université Mohamed V, Rabat, Maroc
| | - Mustapha Bensghir
- Pôle d'Anesthésie-Réanimation, Hôpital Militaire d'Instruction Mohamed V, Faculté de Médecine et de Pharmacie, Université Mohamed V, Rabat, Maroc
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Blaauw J, Jacobs B, den Hertog HM, van der Gaag NA, Jellema K, Dammers R, Lingsma HF, van der Naalt J, Kho KH, Groen RJM. Neurosurgical and Perioperative Management of Chronic Subdural Hematoma. Front Neurol 2020; 11:550. [PMID: 32636797 PMCID: PMC7317017 DOI: 10.3389/fneur.2020.00550] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 05/15/2020] [Indexed: 12/03/2022] Open
Abstract
Objective: Surgery and specifically burr hole craniostomy is the most common first choice treatment of patients with Chronic Subdural Hematoma (CSDH). However, several aspects of neurosurgical and peri-operative management are still a subject of research, such as how to treat bilateral CSDH and the anesthetic approach. We aim to investigate the effect of the surgical approach to bilateral CSDH and the effect of anesthesia modality on outcome of CSDH patients. Methods: We retrospectively included surgically treated CSDH patients between 2005 and 2019 in three hospitals in the Netherlands. The effect of the surgical approach to bilateral CSDH (unilateral vs. bilateral decompression) and anesthesia modality (general vs. local anesthesia) on outcome (complications, recurrence, and length of hospital stay over 4 days) was studied with logistic regression adjusting for potentially confounding radiological and clinical characteristics. Results: Data of 1,029 consecutive patients were analyzed, mean age was 73.5 years (±11) and 75% of patients were male. Bilateral CSDH is independently associated with an increased risk of recurrence within 3 months in logistic regression analysis (aOR 1.7, 95% CI: 1.1-2.5) but recurrence rate did not differ between primary bilateral or unilateral decompression of bilateral CSDH. (15 vs. 17%, p = 0.775). Logistic regression analysis showed that general anesthesia was independently associated with an increased risk of complications (aOR 1.8, 95% CI: 1.0-3.3) and with a length of hospital admission of over 4 days (aOR 8.4, 95% CI: 5.6-12.4). Conclusions: Bilateral CSDH is independently associated with higher recurrence rates. As recurrence rates in bilateral CSDH are similar for different surgical approaches, the optimal choice for primary bilateral decompression of bilateral CSDH could vary per patient. General anesthesia for surgical treatment of CSDH is associated with higher complication rates and longer hospital admission.
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Affiliation(s)
- Jurre Blaauw
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Center for Medical Decision Sciences, Department of Public Health, Erasmus Medical Center, Rotterdam, Netherlands
| | - Bram Jacobs
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | | | - Niels A. van der Gaag
- University Neurosurgical Center Holland (UNCH), Leiden University Medical Center, Haaglanden Medical Center, Haga Teaching Hospital, Leiden, Netherlands
| | - Korné Jellema
- Department of Neurology, Haaglanden Medical Centre, Hague, Netherlands
| | - Ruben Dammers
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus Medical Center, Rotterdam, Netherlands
| | - Hester F. Lingsma
- Center for Medical Decision Sciences, Department of Public Health, Erasmus Medical Center, Rotterdam, Netherlands
| | - Joukje van der Naalt
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Kuan H. Kho
- Department of Neurosurgery, Medisch Spectrum Twente, Enschede, Netherlands
| | - Rob J. M. Groen
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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Romanenko A, Кучин Ю, Бєлка К, Токар І. Perioperative pain management in elderly patients with а proximal femoral fracture: evidence review. PAIN MEDICINE 2020. [DOI: 10.31636/pmjua.v4i4.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The purpose of this article is to compare different methods of analgesia during perioperative period in elderly patients with а proximal femoral fracture. The incidence of hip fracture is high and also rises with the age, for example, In Great Britain, number of patients with a hip fracture will be approximately 100 000 in 2033, and it’s also associated with significant healthcare financing. Nevertheless, effective pain management is a big challenge for clinicians because of considerable problems in geriatric patients, including age, physiological changes in the elderly, preexisting comorbidities, cognitive impairment, high risk of delirium, problems with rehabilitation and probability of an independent life [12]. Opioids are still the main option for hip fracture pain management, despite differences in pharmacokinetics and pharmacodynamics in elderly patients, which are correlated with high frequency of side effects. Opioid-related adverse drug events are associated with worse patient outcomes such as morbidity, mortality and length of stay increase. Therefore, peripheral nerve blocks as part of multimodal analgesic technique can provide more effective pain control after hip fracture. Comprehensive literature searches focus on the use of peripheral nerves blocks as preoperative analgesia, as postoperative analgesia or as a supplement to general anesthesia for hip fracture surgery.
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Alghanem SM, Massad IM, Almustafa MM, Al-Shwiat LH, El-Masri MK, Samarah OQ, Khalil OA, Ahmad M. Relationship between intra-operative hypotension and post-operative complications in traumatic hip surgery. Indian J Anaesth 2020; 64:18-23. [PMID: 32001904 PMCID: PMC6967359 DOI: 10.4103/ija.ija_397_19] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 06/19/2019] [Accepted: 09/03/2019] [Indexed: 12/04/2022] Open
Abstract
Background and Aims: The relationship between intra-operative hypotension and post-operative complications has been recently studied in non-cardiac surgery. Little is known about this relationship in traumatic hip surgery. Our study aimed to investigate this relationship. Methods: A retrospective study was conducted on patients who underwent surgical correction of traumatic hip fracture between 2010 and 2015. We reviewed the perioperative blood pressure readings and the episodes of intra-operative hypotension. Hypotension was defined as ≥30% decrease in the pre-induction systolic blood pressure sustained for ≥10 min. The relationship between intra-operative hypotension and post-operative complications was evaluated. Post-operative complications were defined as new events or diseases that required post-operative treatment for 48 h. Factors studied included type of anaesthesia, blood transfusion rate, pre-operative comorbidities and delay in surgery. We used the Statistical Package for Social Sciences (SPSS, IBM 25) to perform descriptive and non-parametric statistics. Results: A total of 502 patients underwent various types of traumatic hip surgery during the study period. Intra-operative hypotension developed in 91 patients (18.1%) and 42 patients (8.4%) developed post-operative complications. Significantly more patients with hypotension developed post-operative complications compared to patients with stable vitals (18.7% vs. 6.1; P < 0.001). There was no statistically significant difference in the incidence of post-operative complication in patients receiving general or spinal anaesthesia. Pre-operative comorbidities had no significant relationship with post-operative complications. Intra-operative blood transfusion was related to both intra-operative hypotension and post-operative complications. Conclusion: There was an association between intra-operative hypotension and post-operative complications in patients undergoing traumatic hip surgery.
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Affiliation(s)
- Subhi M Alghanem
- Department of Anesthesiology, Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Islam M Massad
- Department of Anesthesiology, Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Mahmoud M Almustafa
- Department of Anesthesiology, Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Luma H Al-Shwiat
- Department of Anesthesiology, Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Mohammad K El-Masri
- Department of Anesthesiology, Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Omar Q Samarah
- Department of Orthopedic, Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Osama A Khalil
- Department of Orthopedic, Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Muayyad Ahmad
- Department of Clinical Nursing, Faculty of Nursing, The University of Jordan, Amman, Jordan
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Prasad GK, Khanna S, Sharma V. Peripheral nerve blocks in trauma patients: Recent updates and improving patient outcomes: A narrative review. INDIAN JOURNAL OF PAIN 2020. [DOI: 10.4103/ijpn.ijpn_70_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Jadon A, Sinha N, Chakraborty S, Ahmad A. An out-of-plane approach for pericapsular nerve group block: A case series. BALI JOURNAL OF ANESTHESIOLOGY 2020. [DOI: 10.4103/bjoa.bjoa_41_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Perioperative multidisciplinary implementation enhancing recovery after hip arthroplasty in geriatrics with preoperative chronic hypoxaemia. Sci Rep 2019; 9:19145. [PMID: 31844090 PMCID: PMC6914796 DOI: 10.1038/s41598-019-55607-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 11/29/2019] [Indexed: 11/19/2022] Open
Abstract
We investigated risk factors for postoperative serious adverse events (SAEs) in elderly patients with preoperative chronic hypoxaemia undergone total hip arthroplasty (THA) or hemiarthroplasty and performed an implementation to modify and improve clinical outcome. A retrospective medical record review was performed to identify geriatric patients who receiving THA or hemiarthroplasty at a single university teaching hospital, Kunming, Yunnan, China between January 2009 and August 2017. Total of 450 elderly patients were included in the study. Data were collected on baseline characteristics, detailed treatments, and adverse events. Univariate and multivariate logistic regression analysis were used to identify risk factors for SAEs. In multivariate regression analysis, a higher occurrence of general anaesthesia and multiple episodes of hypotension were associated with higher risk of SAEs (general anesthesia: odds ratio [OR] 5.09, 95% confidence interval [CI] 1.96–13.24, P = 0.001; hypotension time: OR 4.29, 95% CI 1.66–11.10, P = 0.003). After the multidisciplinary implementation, the postoperative length of stay was decreased from 15 days to 10 days (P < 0.0001); incidence of SAEs was decreased from 21.1% to 7.0% (P = 0.002), and the all-cause mortality rate within 30 days decreased from 4.6% to 1.0% (P = 0.040). Our observational study demonstrated that an increasing application of general anaesthesia and longer time of hypotension were associated with an increased risk of postoperative SAEs in patients after THA or hemiarthroplasty. Additionally, optimizing stable haemodynamics under higher application of combined-spinal epidural anaesthesia was associated with improved outcome up to 30 days after THA or hemiarthroplasty.
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Chen DX, Yang L, Ding L, Li SY, Qi YN, Li Q. Perioperative outcomes in geriatric patients undergoing hip fracture surgery with different anesthesia techniques: A systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e18220. [PMID: 31804347 PMCID: PMC6919429 DOI: 10.1097/md.0000000000018220] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Previous meta-analyses assessing anesthetic techniques in adult patients undergoing hip fractures surgery are available. However, whether the anesthetic technique is associated with risk of mortality and complications in geriatric patients with hip fractures remains unclear. This study was conducted to assess postoperative outcomes of anesthesia technique in geriatric patients undergoing hip fracture surgery. METHODS Cochrane Library, PubMed, EMBASE, MEDLINE, CNKI, and CBM were searched from inception up to May 25, 2018. Observational studies and randomized controlled trials (RCTs) that assessed the perioperative outcomes of technique of anesthesia (general or regional [epidural/spinal/neuraxial]) in geriatric patients (≥60 years old) undergoing hip fracture surgery were included. Two investigators independently screened studies for inclusion and performed data extraction. Heterogeneity was assessed by the I and Chi-square tests. The odds ratio (OR) of the dichotomous data, mean difference (MD) of continuous data, and 95% confidence intervals (CI) were calculated to assess the pooled data. RESULTS Eleven retrospective and 2 RCTs were included. There was no difference in 30-day mortality (OR = 0.96; 95% CI 0.86-1.08; P = .51) between the general and regional anesthesia groups. In-hospital mortality (OR = 1.26; 95% CI 1.17-1.36; P < .001), acute respiratory failure (OR = 2.66; 95% CI 2.34-3.02; P < .001), length of hospital stay (MD = 0.33; 95% CI 0.24-0.42; P < .001), and readmission (OR = 1.09; 95% CI 1.01-1.18; P = .03) were significantly reduced in the regional anesthesia group. Pneumonia (OR = 0.99; 95% CI 0.91-1.07; P = .79), heart failure (OR = 0.97; 95% CI 0.86-1.09; P = .62), acute myocardial infraction (OR = 1.07; 95% CI 0.99-1.16; P = .10), acute renal failure (OR = 1.32; 95% CI 0.97-1.79; P = .07), cerebrovascular accident (OR = 1.08; 95% CI 0.82-1.42; P = .58), postoperative delirium (OR = 1.51; 95% CI 0.16-13.97; P = .72), and deep vein thrombosis/pulmonary embolism (OR = 1.42; 95% CI 0.84-2.38; P = .19) were similar between the two anesthetic techniques. CONCLUSION General anesthesia is associated with increased risk of in-hospital mortality, acute respiratory failure, longer hospital stays, and higher readmission. There is evidence to suggest that regional anesthesia is associated with improved perioperative outcomes. Large RCTs are needed to explore the most optimal anesthetic techniques for geriatric patients with hip fractures before drawing final conclusions. PROSPERO REGISTRATION NUMBER CRD42018093582.
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Affiliation(s)
- Dong Xu Chen
- Department of Anesthesiology, West China Hospital, Sichuan University
| | - Lei Yang
- Department of Anesthesiology, West China Hospital, Sichuan University
| | - Lin Ding
- Department of Anesthesiology, West China Hospital, Sichuan University
| | - Shi Yue Li
- Department of Anesthesiology, West China Hospital, Sichuan University
| | - Ya Na Qi
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Qian Li
- Department of Anesthesiology, West China Hospital, Sichuan University
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Lim BG, Lee IO. Anesthetic management of geriatric patients. Korean J Anesthesiol 2019; 73:8-29. [PMID: 31636241 PMCID: PMC7000283 DOI: 10.4097/kja.19391] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 10/20/2019] [Indexed: 12/15/2022] Open
Abstract
The number of elderly patients who frequently access health care services is increasing worldwide. While anesthesiologists are developing the expertise to care for these elderly patients, areas of concern remain. We conducted a comprehensive search of major international databases (PubMed, Embase, and Cochrane) and a Korean database (KoreaMed) to review preoperative considerations, intraoperative management, and postoperative problems when anesthetizing elderly patients. Preoperative preparation of elderly patients included functional assessment to identify preexisting cognitive impairment or cardiopulmonary reserve, depression, frailty, nutrition, polypharmacy, and anticoagulation issues. Intraoperative management included anesthetic mode and pharmacology, monitoring, intravenous fluid or transfusion management, lung-protective ventilation, and prevention of hypothermia. Postoperative checklists included perioperative analgesia, postoperative delirium and cognitive dysfunction, and other complications. A higher level of perioperative care was required for older surgical patients, as multiple chronic diseases often makes them prone to developing postoperative complications, including functional decline and loss of independence. Although the guiding evidence remains poor so far, elderly patients have to be provided optimal perioperative care through close interdisciplinary, interprofessional, and cross-sectional collaboration to minimize unwanted postoperative outcomes. Furthermore, along with adequate anesthetic care, well-planned postoperative care should begin immediately after surgery and extend until discharge.
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Affiliation(s)
- Byung-Gun Lim
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Il-Ok Lee
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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Abstract
PURPOSE OF REVIEW Hip fracture is common in the elderly population, painful and costly. The present investigation was undertaken to review epidemiology, socio-economic and medical implications, relevant anatomy, and anesthetic and pain modalities of hip fracture. RECENT FINDINGS A literature search of PubMed, Ovid Medline, and Cochrane databases was conducted in December 2018 to identify relevant published clinical trials, review articles, and meta-analyses studies related to anesthetic and pain modalities of hip fracture. The acute pain management in these situations is often challenging. Common issues associated with morbidity and mortality include patients' physiological decrease in function, medical comorbidities, and cognitive impairment, which all can confound and complicate pain assessment and treatment. Perioperative multidisciplinary and multimodal approaches require medical, surgical, and anesthesiology teams employing adequate preoperative optimization. Reduction in pain and disability utilizing opioid and non-opioid therapies, regional anesthesia, patient-tailored anesthetic approach, and delirium prevention strategies seems to ensure best outcomes.
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Choi EJ, Choi YJ, Lee SW, Choi YM, Ri HS, Park JY, Park SJ, Son JM, Lee YS. Effect of anesthetic method on incidence of delirium after total hip replacement arthroplasty in South Korea: a population-based study using National Health Insurance claims data. Korean J Anesthesiol 2019; 73:36-43. [PMID: 31378056 PMCID: PMC7000278 DOI: 10.4097/kja.19091] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 07/22/2019] [Indexed: 11/11/2022] Open
Abstract
Background There are various reports on the effects of the anesthetic method on neurologic complications. A population-based study was conducted to estimate the effect of anesthetic method on the incidence of postoperative delirium in patients that underwent total hip replacement arthroplasty in South Korea. Methods The Korean National Health Insurance claims database was used to retrospectively identify and analyze 24,379 cases of total hip replacement arthroplasty, defined as patients having a claim record with the operation code ‘N0711,’ from January 2008 to December 2017. Patients were divided into two groups, a general anesthesia group (n = 9,921) and a regional anesthesia group (n = 14,458). The incidence of delirium was assessed in cases when patients used medications for delirium, such as haloperidol, chlorpromazine, olanzapine, and risperidone. Results Of the 9,921 patients receiving general anesthesia and 14,458 receiving regional anesthesia, 142 (1.43%) and 209 (0.86%) experienced postoperative delirium after total hip replacement arthroplasty, respectively. There was no significant difference between the groups (P = 0.92). In logistic regression analysis, sex (P = 0.038) and patients with acquired immune deficiency syndrome (P = 0.008) were predictors of postoperative delirium. Conclusions Our results revealed that the anesthetic method was not associated with the incidence of postoperative delirium. In addition, the results suggest that male patients and patients with acquired immune deficiency syndrome undergoing total hip replacement arthroplasty carefully managed for postoperative delirium after surgery.
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Affiliation(s)
- Eun-Ji Choi
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Yoon Ji Choi
- Department of Anesthesiology and Pain Medicine, Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Sang Won Lee
- Department of Anesthesiology and Pain Medicine, Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Yun-Mi Choi
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hyun-Su Ri
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Ju Yeon Park
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Soon Ji Park
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jung-Min Son
- Department of Biostatistics, Clinical Trial Center, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Yoon Sook Lee
- Department of Anesthesiology and Pain Medicine, Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
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Desmarais P, Herrmann N, Alam F, Choi S, Avramescu S. Future Directions for Geriatric Anesthesiology. Anesthesiol Clin 2019; 37:581-592. [PMID: 31337487 DOI: 10.1016/j.anclin.2019.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
"With a rapidly aging world population, it is critical for physicians of every specialty to adapt the ways they provide medical and perioperative care to patients. Older adults represent the largest population of health care users, and they have very different needs and preferences compared with their younger counterparts. In this article, the authors discuss some of the current gaps in geriatric anesthesia and perioperative care, as they elaborate on what can be expected in the near future at different levels of the health care system: the patient, the environment, and the anesthesia specialty."
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Affiliation(s)
- Philippe Desmarais
- Cognitive & Movement Disorders Clinic, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room A455, Toronto, Ontario M4N 3M5, Canada; L.C. Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada; Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada
| | - Nathan Herrmann
- Department of Psychiatry, University of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room FG19, Toronto, Ontario M4N 3M5, Canada
| | - Fahad Alam
- Department of Anesthesia, University of Toronto, 123 Edward Street, Toronto, Ontario M5G 1E2, Canada; Department of Anesthesia, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room M3200, Toronto, Ontario M4N 3M5, Canada
| | - Stephen Choi
- Department of Anesthesia, University of Toronto, 123 Edward Street, Toronto, Ontario M5G 1E2, Canada; Department of Anesthesia, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room M3200, Toronto, Ontario M4N 3M5, Canada
| | - Sinziana Avramescu
- Department of Anesthesia, University of Toronto, 123 Edward Street, Toronto, Ontario M5G 1E2, Canada; Department of Anesthesia, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room M3200, Toronto, Ontario M4N 3M5, Canada; Department of Anesthesia, Humber River Hospital, 1235 Wilson Avenue, Toronto, Ontario M3M 0B2, Canada.
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Soffin EM, Gibbons MM, Wick EC, Kates SL, Cannesson M, Scott MJ, Grant MC, Ko SS, Wu CL. Evidence Review Conducted for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery: Focus on Anesthesiology for Hip Fracture Surgery. Anesth Analg 2019; 128:1107-1117. [PMID: 31094775 DOI: 10.1213/ane.0000000000003925] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Enhanced recovery after surgery (ERAS) protocols represent patient-centered, evidence-based, multidisciplinary care of the surgical patient. Although these patterns have been validated in numerous surgical specialities, ERAS has not been widely described for patients undergoing hip fracture (HFx) repair. As part of the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery, we have conducted a full evidence review of interventions that form the basis of the anesthesia components of the ERAS HFx pathway. A literature search was performed for each protocol component, and the highest levels of evidence available were selected for review. Anesthesiology components of care were identified and evaluated across the perioperative continuum. For the preoperative phase, the use of regional analgesia and nonopioid multimodal analgesic agents is suggested. For the intraoperative phase, a standardized anesthetic with postoperative nausea and vomiting prophylaxis is suggested. For the postoperative phase, a multimodal (primarily nonopioid) analgesic regimen is suggested. A summary of the best available evidence and recommendations for inclusion in ERAS protocols for HFx repair are provided.
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Affiliation(s)
- Ellen M Soffin
- From the Department of Anesthesiology, The Hospital for Special Surgery, New York, New York
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York
| | - Melinda M Gibbons
- Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Elizabeth C Wick
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, Baltimore, Maryland
| | - Stephen L Kates
- Department of Orthopaedic Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Maxime Cannesson
- Department of Anesthesiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Michael J Scott
- Department of Anesthesiology, Virginia Commonwealth University School of Medicine, Richmond, Virginia
- Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael C Grant
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Samantha S Ko
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Christopher L Wu
- From the Department of Anesthesiology, The Hospital for Special Surgery, New York, New York
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York
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Operative and prognostic parameters associated with elective versus emergency surgery in a retrospective cohort of elderly patients. Aging Clin Exp Res 2019; 31:403-410. [PMID: 29845557 DOI: 10.1007/s40520-018-0976-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 05/22/2018] [Indexed: 01/20/2023]
Abstract
AIM To evaluate operative and prognostic parameters associated with elective versus emergency surgery in a retrospective cohort of elderly patients. METHODS A total of 533 geriatric patients (aged ≥ 65 years, median age: 73.0 years, 50.7% were females) who underwent either elective surgery (n = 285) or emergency surgery (n = 248) were included in this study. Data on patient demographics, co-morbid disorders, type of surgery and anesthesia, American Society of Anesthesiologists (ASA) physical status (PS) classification, length of hospital stay, length of ICU stay, hospitalization outcome, prognosis (survivor, non-survivor) were obtained from medical records. RESULTS Emergency surgery group was associated with higher prevalence of ASA-PS III (48.8 vs. 25.6%, p < 0.001) and ASA-PS IV (19.0 vs. 0.4%, p < 0.001) categories and higher mortality rates (20.6 vs. 4.9% vs. p < 0.001) when compared to the elective surgery group. ASA-PS IV category was associated with oldest patient age (median 82.0 vs. 71.0 years for ASA-PS I and II, p < 0.001 for each and versus 75.0 years for ASA-PS III, p < 0.05) and highest mortality rate (35.4 vs. 3.4% for ASA-PS I, 6.0% for ASA-PS II and 16.5% for ASA-PS III, p < 0.001) as compared with other categories. CONCLUSION In conclusion, our findings in a retrospective cohort of elderly surgical patients revealed high prevalence of co-morbidities, predominance of ASA-PS II or ASA-PS III classes and an overall in-hospital mortality rate of 12.2%. Emergency as compared with elective surgery seems to be associated with older age, male gender, ASA-PS III and IV classes, higher likelihood of postoperative ICU transfer and higher mortality rates.
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Patel V, Champaneria R, Dretzke J, Yeung J. Effect of regional versus general anaesthesia on postoperative delirium in elderly patients undergoing surgery for hip fracture: a systematic review. BMJ Open 2018; 8:e020757. [PMID: 30518580 PMCID: PMC6286489 DOI: 10.1136/bmjopen-2017-020757] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 10/17/2018] [Accepted: 10/26/2018] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE Older patients with hip fractures who are undergoing surgery are at high risk of significant mortality and morbidity including postoperative delirium. It is unclear whether different types of anaesthesia may reduce the incidence of postoperative delirium. This systematic review will investigate the impact of anaesthetic technique on postoperative delirium. Other outcomes included mortality, length of stay, complications and functional outcomes. DESIGN Systematic review of randomised controlled trials and non-randomised controlled studies. DATA SOURCES Bibliographic databases were searched from inception to June 2018. Web of Science and ZETOC databases were searched for conference proceedings. Reference lists of relevant articles were checked, and clinical trial registers were searched to identify ongoing trials. ELIGIBILITY CRITERIA Studies were eligible if general and regional anaesthesia were compared in patients (aged 60 and over) undergoing hip fracture surgery, reporting primary outcome of postoperative delirium and secondary outcomes of mortality, length of hospital stay, adverse events, functional outcomes, discharge location and quality of life. Exclusion criteria were anaesthetic technique or drug not considered current standard practice; patients undergoing hip fracture surgery alongside other surgery and uncontrolled studies. RESULTS One hundred and four studies were included. There was no evidence to suggest that anaesthesia type influences postoperative delirium or mortality. Some studies suggested a small reduction in length of hospital stay with regional anaesthesia. There was some evidence to suggest that respiratory complications and intraoperative hypotension were more common with general anaesthesia. Heterogeneity precluded meta-analysis. All findings were described narratively and data were presented where possible in forest plots for illustrative purposes. CONCLUSIONS While there was no evidence to suggest that anaesthesia types influence postoperative delirium, the evidence base is lacking. There is a need to ascertain the impact of type of anaesthesia on outcomes with an adequately powered, methodologically rigorous study. PROSPERO REGISTRATION NUMBER CRD42015020166.
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Affiliation(s)
- Vanisha Patel
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Rita Champaneria
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Janine Dretzke
- Biostatistics, Evidence Synthesis and Test Evaluation (BESaTE), Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Joyce Yeung
- Warwick Medical School, University of Warwick, Coventry, UK
- Department of Anaesthesia and Critical Care, Birmingham Heartlands Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
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Molina Hernández MJ, González de Villaumbrosia C, Martín de Francisco de Murga E, Alarcón Alarcón T, Montero-Fernández N, Illán J, Bielza R, Mora-Fernández J. [Multi-centre register study of hip fractures in Orthogeriatric Units in the Community of Madrid (Spain)]. Rev Esp Geriatr Gerontol 2018; 54:5-11. [PMID: 30131189 DOI: 10.1016/j.regg.2018.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/12/2018] [Accepted: 07/25/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To describe the characteristics of patients with hip fractures admitted over a period of two years (from January 2015 to December 2016) in eight Orthogeriatric Units in public hospitals of the Community of Madrid. MATERIAL AND METHOD This is a descriptive, prospective and multi-centre study. In 2014, all hospitals in Madrid providing joint Geriatric and Traumatology assistance were invited to a recently created orthogeriatric work group. Geriatricians in charge of the Orthogeriatric Unit from eight hospitals took part in this study. The participants established a database including all variables that influenced health outcomes (socio-demographic and clinical variables). RESULTS The study includes 3,995 patients, with a mean age of 85.3years (range: 58-108years old). Two-thirds of them were ASA (American Society Physical Status Classification System) III-IV. Almost all (96.7%) of the patients underwent a surgical operation, and 35.9% of them were operated during the first 48hours. The delay was mainly due to logistic problems (43.5%). The mean hospital stay was 11.2days. Just over half (53.1%) of the patients required a blood transfusion. In-hospital mortality was 5.3%. DISCUSSION Hip fracture registries are essential tools to monitor the healthcare process of these patients, as well as to improve the quality of care. Our results are similar to other records. It would be necessary to improve pre-operative time, which must be less than 48hours in patients without clinical instability. We also need more resources for functional recovery and more uniformity.
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Affiliation(s)
| | | | | | | | - Nuria Montero-Fernández
- Servicio de Geriatría, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital Universitario Gregorio Marañón, Madrid, España
| | - Julia Illán
- Hospital Universitario de Getafe, Getafe, Madrid, España
| | - Rafael Bielza
- Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España
| | - Jesús Mora-Fernández
- Servicio de Geriatría, IdISSC, Hospital Universitario Clínico San Carlos, Madrid, España.
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Norouzi A, Behrouzibakhsh F, Kamali A, Yazdi B, Ghaffari B. Short-term complications of anesthetic technique used in hip fracture surgery in elderly people. Eur J Transl Myol 2018; 28:7355. [PMID: 30344972 PMCID: PMC6176388 DOI: 10.4081/ejtm.2018.7355] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 02/22/2018] [Accepted: 02/23/2018] [Indexed: 02/06/2023] Open
Abstract
Postoperative complications of fracture are one of the main problems in older patients with hip fracture. In this study, complications were observed 48 hours after surgery in different anesthetic procedures. This prospective cross sectional study was carried out over a 12-month period. All subjects over 55 years of age undergoing hip fracture surgery were selected for study with ASA class (American Society of Anesthesiology: one, two and three). After determining the vital signs in the operating room, anesthesia type (general, spinal and epidural) and various variables were recorded. It was observed that the spinal anesthesia method had the lowest level of postoperative disturbances of consciousness and had the shortest duration in terms of duration of time. On the other hand, general anesthesia was the least in terms of blood transfusion. Finally, epidural anesthetic method showed the least amount of pain 48 hours after operation and the least changes in blood pressure and heart rate.
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Affiliation(s)
- Afsaneh Norouzi
- Department of Anesthesiology, Arak University of Medical Sciences, Arak
| | | | - Alireza Kamali
- Department of Anesthesiology, Arak University of Medical Sciences, Arak
| | - Bijan Yazdi
- Department of Anesthesiology, Arak University of Medical Sciences, Arak
| | - Babak Ghaffari
- Department of Orthopedics, Arak University of Medical Sciences, Arak, Iran
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White SM, Foss NB, Griffiths R. Anaesthetic aspects in the treatment of fragility fracture patients. Injury 2018; 49:1403-1408. [PMID: 29958684 DOI: 10.1016/j.injury.2018.06.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 06/21/2018] [Indexed: 02/02/2023]
Abstract
As longevity increases globally, the number of older, frailer, comorbid patients requiring fragility fracture surgery will increase. Fundamentally, anaesthesia should aim to maintain these patients' pre-fracture cognitive and physiological trajectories and facilitate early (ie day 1) postoperative recovery. This review describes the 10 general principles of anaesthesia for fragility fracture surgery that best achieve these aims: multidisciplinary care, 'getting it right first time', timely surgery, standardisation, sympathetic anaesthesia, avoiding ischaemia, sympathetic analgesia, re-enablement, data collection and training.
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Affiliation(s)
- S M White
- FRCA, Brighton and Sussex University Hospitals NHS Trust, Eastern Road, Brighton, East Sussex, BN2 5BE, United Kingdom.
| | - N B Foss
- Department of Anaesthesiology and Intensive Care Medicine, Hvidovre University Hospital, Kettegård Allé 30, Hvidovre, Denmark
| | - R Griffiths
- North West Anglia Hospitals NHS FT, Bretton Gate, Peterborough, PE3 9GZ, United Kingdom
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Sanz-Reig J, Salvador Marín J, Ferrández Martínez J, Orozco Beltrán D, Martínez López J, Quesada Rico J. Prognostic factors and predictive model for in-hospital mortality following hip fractures in the elderly. Chin J Traumatol 2018; 21:163-169. [PMID: 29784590 PMCID: PMC6033736 DOI: 10.1016/j.cjtee.2017.10.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 10/23/2017] [Accepted: 12/04/2017] [Indexed: 02/04/2023] Open
Abstract
PURPOSE The incidence of hip fractures is increasing within the aging population. Our objective was to identify and quantify the risk factors and develop a predictive model for the in-hospital mortality among hip fracture patients older than 65 years. METHODS This is a prospective study conducted on 331 hip fracture patients older than 65 years admitted to our hospital from 2011 to 2014. Patients' demographics, prehospitalization residential status, prefracture comorbidity data, anti-aggregant and anticoagulant medication, preoperative hemoglobin value, type of fractures, type of treatments, time to surgery, and complications were recorded. RESULTS The average age was 83 years, 73% female, and 57% of them sustained a femoral neck fracture. In 62.8% of patients, the number of pre-fracture baseline comorbidities was ≥2. The in-hospital mortality rate was 11.4%. In multivariate analysis, age over 90 years, congestive heart failure, asthma, rheumatologic disease, lung cancer, and not taking antiaggregant medication were independently associated with in-hospital mortality. A formula and risk stratification scoring for predicting the risk for in-hospital mortality was developed. Risk-adjustment model based on these variables had acceptable accuracy for predicting in-hospital mortality (c-statistic 0.77). CONCLUSION Advanced age, and five prefracture comorbidities have a strong association with in-hospital mortality in a hip fracture patient older than 65 years old. Our predictive model was specifically designed for the old hip fracture population. It has an accuracy similar to other risk models. The specificity, positive predictive value, and negative predictive value are high. In addition, it could discriminate a high risk patient from a low risk patient for in-hospital mortality.
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Affiliation(s)
- J. Sanz-Reig
- Department of Orthopedic Surgery, Sant Joan d' Alacant University Hospital, Alicante, Spain,Corresponding author.
| | - J. Salvador Marín
- Department of Orthopedic Surgery, Sant Joan d' Alacant University Hospital, Alicante, Spain
| | - J. Ferrández Martínez
- Department of Orthopedic Surgery, Sant Joan d' Alacant University Hospital, Alicante, Spain
| | | | - J.F. Martínez López
- Department of Orthopedic Surgery, Sant Joan d' Alacant University Hospital, Alicante, Spain
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Desai V, Chan PH, Prentice HA, Zohman GL, Diekmann GR, Maletis GB, Fasig BH, Diaz D, Chung E, Qiu C. Is Anesthesia Technique Associated With a Higher Risk of Mortality or Complications Within 90 Days of Surgery for Geriatric Patients With Hip Fractures? Clin Orthop Relat Res 2018; 476:1178-1188. [PMID: 29601378 PMCID: PMC6263607 DOI: 10.1007/s11999.0000000000000147] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Postoperative mortality and complications after geriatric hip fracture surgery remain high despite efforts to improve perioperative care for these patients. One factor of particular interest is anesthetic technique, but prior studies on this are limited by sample selection, competing risks, and incomplete followup. QUESTIONS/PURPOSES (1) Among older patients undergoing surgery for hip fracture, does 90-day mortality differ depending on the type of anesthesia received? (2) Do 90-day emergency department returns and hospital readmissions differ based on anesthetic technique after geriatric hip fracture repairs? (3) Do 90-day Agency for Healthcare Research and Quality (AHRQ) outcomes differ according to anesthetic techniques used during hip fracture surgery? METHODS We conducted a retrospective study on geriatric patients (65 years or older) with hip fractures between 2009 and 2014 using the Kaiser Permanente Hip Fracture Registry. A total of 1995 (11%) of the surgically treated patients with hip fracture were excluded as a result of missing anesthesia information. The final study sample consisted of 16,695 patients. Of these, 2027 (12%) died and 98 (< 1%) terminated membership during followup, which were handled as competing events and censoring events, respectively. Ninety-day mortality, emergency department returns, hospital readmission, deep vein thrombosis (DVT) or pulmonary embolism (PE), myocardial infarction (MI), and pneumonia were evaluated using multivariable competing risk proportional subdistribution hazard regression according to type of anesthesia technique: general anesthesia, regional anesthesia, or conversion from regional to general. Of the 16,695 patients, 58% (N = 9629) received general anesthesia, 40% (N = 6597) received regional anesthesia, and 2.8% (N = 469) patients were converted from regional to general. RESULTS Compared with regional anesthesia, patients treated with general anesthesia had a higher likelihood of overall 90-day mortality (hazard ratio [HR], 1.22; 95% confidence interval [CI], 1.11-1.35; p < 0.001); however, when stratified by before and after hospital discharge but within 90 days of surgery, this higher risk was only observed during the inpatient stay (HR, 3.83; 95% CI, 3.18-4.61; p < 0.001); no difference was observed after hospital discharge (HR, 1.04; 95% CI, 0.94-1.16; p = 0.408). Patients undergoing conversion from regional to general also had a higher overall mortality risk compared with those undergoing regional anesthesia (HR, 1.34; 95% CI 1.04-1.74; p = 0.026), but this risk was only observed during their inpatient stay (HR, 6.84; 95% CI, 4.21-11.11; p < 0.001) when stratifying by before and after hospital discharge. Patients undergoing general anesthesia had a higher risk for all-cause readmission when compared with regional anesthesia (HR, 1.09; 95% CI, 1.01-1.19; p = 0.026). No differences according to anesthesia type were observed for risk of 90-day AHRQ outcomes, including DVT/PE, MI, and pneumonia. CONCLUSIONS We found the use of general anesthesia and conversion from regional to general anesthesia were associated with a higher risk of mortality during the in-hospital stay compared with regional anesthetic techniques, but this higher risk did not persist after hospital discharge. We also found general anesthesia to be associated with a higher risk of all-cause readmission compared with regional, but no other differences were observed in risk for complications. Our findings suggest regional anesthetic techniques may be preferred when possible in this patient population. LEVEL OF EVIDENCE Level III, therapeutic study.
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White SM, Altermatt F, Barry J, Ben-David B, Coburn M, Coluzzi F, Degoli M, Dillane D, Foss NB, Gelmanas A, Griffiths R, Karpetas G, Kim JH, Kluger M, Lau PW, Matot I, McBrien M, McManus S, Montoya-Pelaez LF, Moppett IK, Parker M, Porrill O, Sanders RD, Shelton C, Sieber F, Trikha A, Xuebing X. International Fragility Fracture Network Delphi consensus statement on the principles of anaesthesia for patients with hip fracture. Anaesthesia 2018; 73:863-874. [DOI: 10.1111/anae.14225] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2018] [Indexed: 01/16/2023]
Affiliation(s)
- S. M. White
- Brighton and Sussex University Hospitals NHS Trust; Brighton East Sussex UK
| | - F. Altermatt
- División de Anestesiología; Escuela de Medicina; Pontificia Universidad Católica de Chile; Santiago Chile
| | - J. Barry
- Cairns Hospital; Queensland Australia
| | - B. Ben-David
- University of Pittsburgh Medical Centre; Pittsburgh PA USA
| | - M. Coburn
- Medical Faculty; RWTH Aachen University; Aachen Germany
| | - F. Coluzzi
- Department Medical and Surgical Sciences and Biotechnologies; Sapienza University of Rome; Latina Italy
| | - M. Degoli
- Ospedale Civile di Baggiovara; Azienda Ospedaliero Universitaria di Modena; Modena Italy
| | - D. Dillane
- Anesthesiology and Pain Medicine; University of Alberta; Canada
| | - N. B. Foss
- Department of Anaesthesiology and Intensive Care Medicine; Hvidovre University Hospital; Hvidovre Denmark
| | - A. Gelmanas
- Hospital of Lithuanian University of Health Sciences Kauno klinikos; Lithuania
| | - R. Griffiths
- Peterborough and Stamford Hospitals NHS Trust; Peterborough UK
| | - G. Karpetas
- General University Hospital of Patras; Rio Greece
| | - J.-H. Kim
- Korea University College of Medicine; Seoul South Korea
| | | | - P.-W. Lau
- University of Hong Kong; Hong Kong China
| | - I. Matot
- Critical Care and Pain; Tel Aviv Medical Center; Sackeler School of Medicine; Tel Aviv Israel
| | | | | | - L. F. Montoya-Pelaez
- Department of Anaesthesia and Perioperative Medicine; Groote Schuur Hospital; University of Cape Town; Cape Town South Africa
| | - I. K. Moppett
- Anaesthesia and Critical Care Section; Division of Clinical Neuroscience; Queen's Medical Centre Campus; Nottingham University Hospitals NHS Trust; University of Nottingham; Nottingham UK
| | - M. Parker
- Peterborough and Stamford Hospitals NHS Trust; Peterborough UK
| | - O. Porrill
- New Somerset Hospital; University of Cape Town; South Africa
| | | | - C. Shelton
- Lancaster Medical School and Wythenshawe Hospital; Manchester UK
| | - F. Sieber
- Johns Hopkins Bayview Medical Center; Baltimore MD USA
| | - A. Trikha
- All India Institute of Medical Sciences; New Delhi India
| | - X. Xuebing
- University of Hong Kong-Shenzhen Hospital; Shenzhen China
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Niskakangas M, Dahlbacka S, Liisanantti J, Vakkala M, Kaakinen T. Spinal or general anaesthesia for lower-limb amputation in peripheral artery disease - a retrospective cohort study. Acta Anaesthesiol Scand 2018; 62:226-233. [PMID: 29063607 DOI: 10.1111/aas.13019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 08/27/2017] [Accepted: 09/27/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND The present study aimed to determine which method of anaesthesia (spinal anaesthesia or general anaesthesia) is better in reducing post-operative analgesic requirements in patients undergoing major limb amputation for lower-limb ischaemia. Another aim was to find out if anaesthesiologists use neuraxial anaesthesia in high-risk patients despite abnormal coagulation profile or use of anticoagulation. METHODS The study was a retrospective cohort study. All patients undergone above-the-knee amputation or below-the-knee amputation due to peripheral artery disease between 1996 and 2010 were reviewed to evaluate post-operative opioid consumption and complications. RESULTS A total of 434 amputations in 323 patients were included in the study. The number of surgical complications, the need for surgical revision and the number of intensive care unit admissions were significantly higher in the general anaesthesia group. The need for post-operative opioid medication was significantly lower in patients with above-the-knee amputation and spinal anaesthesia. The use of post-operative epidural analgesia did not reduce analgesic requirements. In the present study, there were patients who received neuraxial anaesthesia despite abnormal coagulation profile or uninterrupted warfarin or clopidogrel. There were no reported cases of spinal or epidural haematoma. CONCLUSION Patients with spinal anaesthesia had a lower rate of surgical complications, re-operations and intensive care unit admissions. Patients with above-the-knee amputation and spinal anaesthesia had a lesser need for opioid medication in the post-operative period than patients with general anaesthesia. Anaesthesiologists performed neuraxial anaesthesia and/or analgesia in high-risk patients despite abnormal coagulation profile or ongoing anticoagulation, but no adverse outcomes were reported.
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Affiliation(s)
- M. Niskakangas
- Department of Surgery; Oulu University Hospital; Oulu Finland
| | - S. Dahlbacka
- Department of Surgery; Oulu University Hospital; Oulu Finland
- Department of Vascular Surgery; Vaasa Central Hospital; Vaasa Finland
| | - J. Liisanantti
- Department of Anaesthesiology; Oulu University Hospital; Oulu Finland
- Division of Intensive Care Medicine; Oulu University Hospital; Oulu Finland
- Research Group of Surgery, Anesthesiology and Intensive Care Medicine; Medical Research Center of Oulu University; Oulu University Hospital; Oulu Finland
| | - M. Vakkala
- Department of Anaesthesiology; Oulu University Hospital; Oulu Finland
- Research Group of Surgery, Anesthesiology and Intensive Care Medicine; Medical Research Center of Oulu University; Oulu University Hospital; Oulu Finland
| | - T. Kaakinen
- Department of Anaesthesiology; Oulu University Hospital; Oulu Finland
- Research Group of Surgery, Anesthesiology and Intensive Care Medicine; Medical Research Center of Oulu University; Oulu University Hospital; Oulu Finland
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Lin JDC, Ouanes JPP, Sieber FE. Regional Versus General Anesthesia in the Elderly: New Insights. CURRENT ANESTHESIOLOGY REPORTS 2017. [DOI: 10.1007/s40140-017-0236-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Complications after hip fracture surgery: are they preventable? Eur J Trauma Emerg Surg 2017; 44:573-580. [PMID: 28795198 PMCID: PMC6096618 DOI: 10.1007/s00068-017-0826-2] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 07/31/2017] [Indexed: 01/22/2023]
Abstract
Purpose Surgery for hip fractures is frequently followed by complications that hinder the rehabilitation of patients. The aim of this study was to describe the incidence rate and type of complications, including mortality, after hip fracture surgery, and to identify the risk factors of these complications that may be amenable to prevention. Methods Prospective cohort study of all consecutive patients aged ≥60 treated for a hip fracture at University Medical Center Groningen between July 2009 and June 2013. All patients were treated in a comprehensive multidisciplinary care pathway. Logistic regression analyses were used to investigate which variables were significant risk factors for the occurrence of complications. Additional analyses were conducted to investigate whether the independent variables were significant risk factors for several specific complications and mortality. Results The study population consisted of 479 patients with a mean age of 78.4 (SD 9.5) years; 33% were men. The overall complication rate was 75%. Delirium was the complication seen most frequently (19%); the incidence of surgical complications was 9%. Most risk factors for complications were not preventable (high comorbidity rate, high age and dependent living situation). However, general anesthesia (OR 1.51; 95% CI 0.97–2.35) and delay in surgery (OR 3.16; 95% CI 1.43–6.97) may be risk factors that can potentially be prevented. Overall, the mortality risk was not higher in patients with a complication, but delirium and pneumonia were risk factors for mortality. Conclusion The overall complication rate after hip fracture surgery was high. Only few complications were potentially preventable.
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Sanz-Reig J, Salvador Marín J, Pérez Alba J, Ferrández Martínez J, Orozco Beltrán D, Martínez López J. Risk factors for in-hospital mortality following hip fracture. Rev Esp Cir Ortop Traumatol (Engl Ed) 2017. [DOI: 10.1016/j.recote.2017.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Van Waesberghe J, Stevanovic A, Rossaint R, Coburn M. General vs. neuraxial anaesthesia in hip fracture patients: a systematic review and meta-analysis. BMC Anesthesiol 2017; 17:87. [PMID: 28659127 PMCID: PMC5490182 DOI: 10.1186/s12871-017-0380-9] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 06/21/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Hip fracture is a trauma of the elderly. The worldwide number of patients in need of surgery after hip fracture will increase in the coming years. The 30-day mortality ranges between 4 and 14%. Patients' outcome may be improved by anaesthesia technique (general vs. neuraxial anaesthesia). There is a dearth of evidence from randomised studies regarding to the optimal anaesthesia technique. However, several large non-randomised studies addressing this question have been published from the onset of 2010. METHODS To compare the 30-day mortality rate, in-hospital mortality rate and length of hospital stay after neuraxial (epidural/spinal) or general anaesthesia in hip fracture patients (≥ 18 years old) we prepared a systematic review and meta-analysis. A systematic search for appropriate retrospective observational and prospective randomised studies in Embase and PubMed databases was performed in the time-period from 01.01.2010 to 21.11.2016. Additionally a forward searching in google scholar, a level one reference list searching and a formal searching of trial registries was performed. RESULTS Twenty retrospective observational and three prospective randomised controlled studies were included. There was no difference in the 30-day mortality [OR 0.99; 95% CI (0.94 to 1.04), p = 0.60] between the general and the neuraxial anaesthesia group. The in-hospital mortality [OR 0.85; 95% CI (0.76 to 0.95), p = 0.004] and the length of hospital stay were significantly shorter in the neuraxial anaesthesia group [MD -0.26; 95% CI (-0.36 to -0.17); p < 0.00001]. CONCLUSION Neuraxial anaesthesia is associated with a reduced in-hospital mortality and length of hospitalisation. However, type of anaesthesia did not influence the 30-day mortality. In future there is a need for large randomised studies to examine the association between the type of anaesthesia, post-operative complications and mortality.
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Affiliation(s)
- Julia Van Waesberghe
- Department of Anaesthesiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Ana Stevanovic
- Department of Anaesthesiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Rolf Rossaint
- Department of Anaesthesiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Mark Coburn
- Department of Anaesthesiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
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