Does general anesthesia compared to regional anesthesia affect postoperative complications and mortality in older adults with dementia undergoing hip fracture surgery?
In older adults with dementia undergoing hip fracture surgery, general anesthesia and regional anesthesia are associated with similar 30-day mortality, though general anesthesia is linked to higher ICU admission rates.
OBJECTIVES: To examine the association between anesthetic technique and postoperative complications in older adults with dementia undergoing hip fracture surgery. DESIGN: Population-based, retrospective cohort study. SETTING: Ontario, Canada. PARTICIPANTS: All older adults with dementia who underwent surgery for hip fracture repair in Ontario, Canada, between April 1, 2003 and March 31, 2011. MEASUREMENTS: The baseline characteristics of individuals who received general anesthesia (GA) and regional anesthesia (RA) were compared. Individuals who received GA were matched to similar individuals who received RA using propensity scores to control for confounding, and their outcomes compared, including 30-day mortality, intensive care unit (ICU) admissions, specific postoperative medical complications, and hospital length of stay (LOS). RESULTS: In the 6,135 matched pairs, there was no statistically significant difference in postoperative 30-day mortality (GA, 11.3%; RA, 10.8%, P = .44). There were no statistically significant differences in the rates of specific postoperative medical complications or LOS in the two anesthetic groups, but GA was associated with higher rates of ICU admissions (6.1% vs 4.2%, P < .001). CONCLUSION: For older adults with dementia undergoing hip fracture surgery, GA and RA are associated with similar rates of most perioperative adverse events. Further studies are required to determine the optimal methods of providing anesthesia and perioperative care for older adults with dementia undergoing surgical procedures.
Seitz et al. (2014) studied this question.