Key result
Combining general and spinal anesthesia for hip fracture surgery increased 12-month mortality (HR 1.17; 95% CI 1.04-1.31), while regional nerve blocks in the ED and OT reduced long-term mortality.
Why the study?
It is debated whether anesthetic and analgesic techniques are associated with altered risk for outcomes in hip fracture patients.
Does the type of anesthesia or use of regional nerve blocks affect 12-month and long-term mortality in patients undergoing hip fracture surgery?
Cohort (n=17,635)
Yes
Does the type of anesthesia or use of regional nerve blocks affect 12-month and long-term mortality in patients undergoing hip fracture surgery?
Hazard Ratio: 1.17 (95% CI 1.04–1.31)
p-value: p=<0.001
In hip fracture surgery, spinal vs general anesthesia does not affect 12-month mortality, but combined anesthesia increases risk, while regional nerve blocks in both ED and OT reduce long-term mortality.
Should not yet change anesthesia practice in hip fracture surgery; leaves open causal effects of combined techniques and nerve blocks on mortality.
INTRODUCTION: Hip 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. METHODS: Data 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. RESULTS: 12-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). CONCLUSION: There 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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Lin et al. (2022) conducted a cohort in Hip fracture (n=17,635). Combination of general and spinal anesthesia vs. General or spinal anesthesia alone was evaluated on All cause 12-month mortality (HR 1.17, 95% CI 1.04 to 1.31, p=<0.001). Combining general and spinal anesthesia for hip fracture surgery increased 12-month mortality (HR 1.17; 95% CI 1.04-1.31), while regional nerve blocks in the ED and OT reduced long-term mortality.
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