General vs. neuraxial anaesthesia in hip fracture patients: a systematic review and meta-analysis

BACKGROUND: Hip fracture is a trauma of the elderly. The worldwide number of patients in need of surgery after hip fracture will increase in the coming years. The 30-day mortality ranges between 4 and 14%. Patients' outcome may be improved by anaesthesia technique (general vs. neuraxial anaesthesia). There is a dearth of evidence from randomised studies regarding to the optimal anaesthesia technique. However, several large non-randomised studies addressing this question have been published from the onset of 2010. METHODS: To compare the 30-day mortality rate, in-hospital mortality rate and length of hospital stay after neuraxial (epidural/spinal) or general anaesthesia in hip fracture patients (≥ 18 years old) we prepared a systematic review and meta-analysis. A systematic search for appropriate retrospective observational and prospective randomised studies in Embase and PubMed databases was performed in the time-period from 01.01.2010 to 21.11.2016. Additionally a forward searching in google scholar, a level one reference list searching and a formal searching of trial registries was performed. RESULTS: Twenty retrospective observational and three prospective randomised controlled studies were included. There was no difference in the 30-day mortality OR 0.99; 95% CI (0.94 to 1.04), p = 0.60 between the general and the neuraxial anaesthesia group. The in-hospital mortality OR 0.85; 95% CI (0.76 to 0.95), p = 0.004 and the length of hospital stay were significantly shorter in the neuraxial anaesthesia group MD -0.26; 95% CI (-0.36 to -0.17); p < 0.00001. CONCLUSION: Neuraxial anaesthesia is associated with a reduced in-hospital mortality and length of hospitalisation. However, type of anaesthesia did not influence the 30-day mortality. In future there is a need for large randomised studies to examine the association between the type of anaesthesia, post-operative complications and mortality.