Regional anaesthesia was associated with lower 30-day mortality compared to general anaesthesia in elderly patients undergoing hip fracture surgery (2.24% vs 2.55%, p=0.0047).
Cohort (n=96,289)
Yes
Does regional anaesthesia reduce 30-day mortality and complications compared to general anaesthesia in elderly patients undergoing hip fracture surgery?
Regional anesthesia is associated with lower 30-day mortality, delirium, ICU admission, and ventilator care compared to general anesthesia in elderly patients undergoing hip fracture surgery.
Absolute Event Rate: 2.24% vs 2.55%
p-value: p=0.0047
OBJECTIVE: To evaluate the effects of anaesthesia on postoperative outcome in elderly patients who underwent hip fracture surgery. SETTING: Nationwide National Health Insurance Sharing Service database of Korea. PARTICIPANTS: All patients aged ≥65 years old who underwent hip fracture surgery, covered by the Korean National Health Insurance, between 1 January 2009 and 31 December 2015. INTERVENTIONS: Hip fracture surgery under general anaesthesia (group GA) or regional anaesthesia (group RA), with a principal diagnosis of femoral fracture. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was the anaesthetic-type effect on 30-day mortality and the secondary outcome was postoperative delirium requiring pharmacological intervention. RESULTS: Among the 96 289 patients who underwent hip fracture surgery, 25 593 and 70 696 patients received GA and RA, respectively. After propensity score matching, 25 593 remained in each group. Postmatching mortality was lower in the RA than in the GA group (574 (2.24%) vs 654 (2.55%), p=0·0047, 95% CI -0.0099 to 0.0159). Delirium incidence was lower in the RA than in the GA group (5187 (20.27%) vs 5828 (22.77%), p<0·0001, 95% CI 0.019 to 0.045). The incidence of intensive care unit stay and ventilator care was lower in the RA than in the GA group (5838 (22.1%) vs 8055 (31.47%), p<0·0001, 95% CI 0.046 to 0.070 and 459 (1.73%) vs 1207 (4.72%), p<0·0001, 95% CI -0.0024 to 0.023, respectively). CONCLUSION: RA was associated with better outcomes than GA, in terms of mortality, delirium, intensive care unit admission and ventilator care, in elderly patients who underwent hip fracture surgery.
Ahn et al. (2019) conducted a cohort in hip fracture (n=96,289). Regional anaesthesia vs. General anaesthesia was evaluated on 30-day mortality (95% CI -0.0099 to 0.0159, p=0.0047). Regional anaesthesia was associated with lower 30-day mortality compared to general anaesthesia in elderly patients undergoing hip fracture surgery (2.24% vs 2.55%, p=0.0047).