Propensity Score–matched Comparison of Postoperative Adverse Outcomes between Geriatric Patients Given a General or a Neuraxial Anesthetic for Hip Surgery

BACKGROUND: The effects of the mode of anesthesia on major adverse postoperative outcomes in geriatric patients are still inconclusive. The authors hypothesized that a neuraxial anesthetic (NA) rather than a general anesthetic (GA) would yield better in-hospital postoperative outcomes for geriatric patients undergoing hip surgery. METHODS: The authors used data from Taiwan's 1997-2011 in-patient claims database to evaluate the effect of anesthesia on in-hospital outcomes. The endpoints were mortality, stroke, transient ischemic stroke, myocardial infarction, respiratory failure, and renal failure. Of the 182, 307 geriatric patients who had hip surgery, a GA was given to 53, 425 (29. 30%) and an NA to 128, 882 (70. 70%). To adjust for baseline differences and selection bias, patients were matched on propensity scores, which left 52, 044 GA and 52, 044 NA patients. RESULTS: GA-group patients had a greater percentage and higher odds of adverse in-hospital outcomes than did NA-group patients: death (2. 62 vs. 2. 13%; odds ratio OR, 1. 24; 95% CI, 1. 15 to 1. 35; P < 0. 001), stroke (1. 61 vs. 1. 38%; OR, 1. 18, 95% CI, 1. 07 to 1. 31; P = 0. 001), respiratory failure (1. 67 vs. 0. 63%; OR, 2. 71; 95% CI, 2. 38 to 3. 01; P < 0. 001), and intensive care unit admission (11. 03 vs. 6. 16%; OR, 1. 95; 95% CI, 1. 87 to 2. 05; P < 0. 001), analyzed using conditional logistic regression. Moreover, patients given a GA had longer hospital stays (10. 77 ± 8. 23 vs. 10. 44 ± 6. 67 days; 95% CI, 0. 22 to 0. 40; P < 0. 001) and higher costs (New Taiwan Dollars NT 86, 606 ± NT74, 162 vs. NT74, 494 ± NT45, 264; 95% CI, 11, 366 to 12, 859; P < 0. 001). CONCLUSION: For geriatric patients undergoing hip surgery, NA was associated with fewer odds of adverse outcomes than GA.