Why the study?
Total hip arthroplasty for femoral neck fractures in elderly patients presents challenges for anesthesiologists, with limited data on anesthesia-related issues and risk factors for morbidity and mortality.
Does the choice of anesthetic technique (general vs spinal) impact morbidity and mortality in elderly patients undergoing total hip arthroplasty for femoral neck fractures?
Observational (n=79)
No
Does the choice of anesthetic technique (general vs spinal) impact morbidity and mortality in elderly patients undergoing total hip arthroplasty for femoral neck fractures?
Odds Ratio: 4.1 (95% CI 1.22–13.8)
Absolute Event Rate: 49.1% vs 19%
p-value: p=0.017
In elderly patients undergoing THA for femoral neck fractures, spinal anesthesia reduces intraoperative hypotension but increases chronic pain compared to general anesthesia, with overall prognosis driven by comorbidities rather than anesthetic technique.
Should not yet change anesthetic selection in elderly THA; leaves open effects on mortality and overall morbidity.
Introduction Total hip arthroplasty (THA) for femoral neck fractures in elderly patients presents challenges for both surgeons and anesthesiologists. This study aimed to describe anesthesia-related issues and analyze risk factors for morbidity and mortality. Materials and methods This retrospective study was conducted over a four-year period in the Department of Anesthesiology, Mohammed V Military Teaching Hospital in Rabat, Morocco. It included patients aged ≥50 years who underwent surgery for femoral neck fractures and received THA. Results Seventy-nine patients were included, with a mean age of 66.8 ± 10.1 years; 81% were between 50 and 75 years old. Domestic accidents accounted for 62% of fractures. General anesthesia (GA) was administered to 55 patients (69.6%), while 30.4% received spinal anesthesia. Postoperative complications were primarily pain, anemia, and cognitive disorders. Mortality rates at 30 days, three months, and one year were 1.2% (1/79), 6.3% (5/79), and 15.2% (12/79), respectively. Increased mortality risk was associated with type 1 diabetes, anticoagulant use, intraoperative hypotension, perioperative blood transfusion, and longer hospitalization. Spinal anesthesia was associated with a reduced risk of intraoperative hypotension (p = 0.017) but a higher incidence of chronic pain compared with GA (33.3% vs. 12.7%, p = 0.032). Conclusions Outcomes in elderly patients undergoing THA for femoral neck fractures are influenced by comorbidities, prior treatments, and the perioperative course. The choice of anesthetic technique and timing of surgery appear to have a limited impact on prognosis.
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Ababou et al. (2025) conducted an observational in Femoral neck fractures requiring total hip arthroplasty (n=79). General anesthesia vs. Spinal anesthesia was evaluated on Intraoperative hypotension (OR 4.10, 95% CI 1.22-13.8, p=0.017).
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