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Impact of Anesthesia on Hospital Mortality and Morbidities in Geriatric Patients Following Emergency Hip Fracture Surgery

Qiu, Chunyuan MD, MS*; Chan, Priscilla H. MS; Zohman, Gary L. MD; Prentice, Heather A. PhD, MPH§; Hunt, Jessica J. MA; LaPlace, Diana C. MD*; Nguyen, Vu T. MD*; Diekmann, Glenn R. MD; Maletis, Gregory B. MD; Desai, Vimal MD*

Journal of Orthopaedic Trauma: March 2018 - Volume 32 - Issue 3 - p 116–123
doi: 10.1097/BOT.0000000000001035
Original Article
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Objectives: To determine the impact of anesthesia type on in-hospital mortality and morbidity for geriatric fragility hip fracture surgery.

Design: Retrospective cohort study.

Setting: Integrates health care delivery system across 38 facilities in the United States.

Patients/Participants: We identified 16,695 patients 65 years of age and older who underwent emergent hip fracture repairs between 2009 and 2014 through the Kaiser Permanente hip fracture registry and excluded pathologic or bilateral fractures.

Intervention: Hip fracture surgery with general or regional anesthesia.

Main Outcomes Measures: Data on in-hospital mortality, time to death, discharge disposition, and length of stay (LOS) were analyzed among the following anesthesia types: general anesthesia (GA), regional anesthesia (RA), and intraoperative conversions from regional to general (Cv).

Results: Compared with RA, the hazard ratio for GA for in-hospital mortality was 1.38 and 2.23 for the Cv group; the time ratio for GA-associated time to death was 0.97 and 0.89 for the Cv group. The GA-associated time ratio for LOS before discharge was 1.01, and the hazard ratio for home discharge was 0.86, but no significance was found with the Cv group.

Conclusions: RA may offer advantages over GA for fragility hip fracture surgeries when possible. In-hospital mortality, time to death, increased LOS, and discharge to an institute rather than home were all adversely influenced by GA. Furthermore, the previously understudied Cv group demonstrated adverse outcomes for in-hospital mortality and time to death.

Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

*Department of Anesthesiology, Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, CA;

Department of Surgical Outcomes and Analysis, Kaiser Permanente San Diego Medical Center, San Diego, CA;

Department of Orthopaedic Surgery, Kaiser Permanente Orange County Medical Center, Orange, CA;

§Department of SCPMG Clinical Analysis, Kaiser Permanente San Diego Medical Center, San Diego, CA; and

Department of Orthopaedic Surgery, Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, CA.

Reprints: Chunyuan Qiu, MD, MS, Department of Anesthesiology, Kaiser Permanente Baldwin Park Medical Center, 1011 Baldwin Park Boulevard, Baldwin Park, CA 91706 (e-mail: Chunyuan.x.Qiu@kp.org).

The authors report no conflict of interest.

Presented as a poster at the Annual Meeting of the 6th International Congress of Arthroplasty Registries, May 21, 2017, San Francisco, CA.

Accepted September 15, 2017

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.