Comparative effectiveness of regional versus general anesthesia for hip fracture surgery in adults

Mark D. Neuman, Jeffrey H. Silber, Nabil M. Elkassabany, Justin M. Ludwig, Lee A. Fleisher

Research output: Contribution to journalArticle

Abstract

Background: Hip fracture is a common, morbid, and costly event among older adults. Data are inconclusive as to whether epidural or spinal (regional) anesthesia improves outcomes after hip fracture surgery. Methods: The authors examined a retrospective cohort of patients undergoing surgery for hip fracture in 126 hospitals in New York in 2007 and 2008. They tested the association of a record indicating receipt of regional versus general anesthesia with a primary outcome of inpatient mortality and with secondary outcomes of pulmonary and cardiovascular complications using hospital fixed-effects logistic regressions. Subgroup analyses tested the association of anesthesia type and outcomes according to fracture anatomy. Results: Of 18,158 patients, 5,254 (29%) received regional anesthesia. In-hospital mortality occurred in 435 (2.4%). Unadjusted rates of mortality and cardiovascular complications did not differ by anesthesia type. Patients receiving regional anesthesia experienced fewer pulmonary complications (359 [6.8%] vs. 1,040 [8.1%], P <0.005). Regional anesthesia was associated with a lower adjusted odds of mortality (odds ratio: 0.710, 95% CI 0.541, 0.932, P = 0.014) and pulmonary complications (odds ratio: 0.752, 95% CI 0.637, 0.887, P <0.0001) relative to general anesthesia. In subgroup analyses, regional anesthesia was associated with improved survival and fewer pulmonary complications among patients with intertrochanteric fractures but not among patients with femoral neck fractures. Conclusions: Regional anesthesia is associated with a lower odds of inpatient mortality and pulmonary complications among all hip fracture patients compared with general anesthesia; this finding may be driven by a trend toward improved outcomes with regional anesthesia among patients with intertrochanteric fractures.

Original languageEnglish (US)
Pages (from-to)72-92
Number of pages21
JournalAnesthesiology
Volume117
Issue number1
DOIs
StatePublished - Jul 2012
Externally publishedYes

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Conduction Anesthesia
Hip Fractures
General Anesthesia
Lung
Mortality
Inpatients
Anesthesia
Odds Ratio
Femoral Neck Fractures
Spinal Anesthesia
Hospital Mortality
Anatomy
Logistic Models
Survival

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Neuman, M. D., Silber, J. H., Elkassabany, N. M., Ludwig, J. M., & Fleisher, L. A. (2012). Comparative effectiveness of regional versus general anesthesia for hip fracture surgery in adults. Anesthesiology, 117(1), 72-92. https://doi.org/10.1097/ALN.0b013e3182545e7c

Comparative effectiveness of regional versus general anesthesia for hip fracture surgery in adults. / Neuman, Mark D.; Silber, Jeffrey H.; Elkassabany, Nabil M.; Ludwig, Justin M.; Fleisher, Lee A.

In: Anesthesiology, Vol. 117, No. 1, 07.2012, p. 72-92.

Research output: Contribution to journalArticle

Neuman, MD, Silber, JH, Elkassabany, NM, Ludwig, JM & Fleisher, LA 2012, 'Comparative effectiveness of regional versus general anesthesia for hip fracture surgery in adults', Anesthesiology, vol. 117, no. 1, pp. 72-92. https://doi.org/10.1097/ALN.0b013e3182545e7c
Neuman, Mark D. ; Silber, Jeffrey H. ; Elkassabany, Nabil M. ; Ludwig, Justin M. ; Fleisher, Lee A. / Comparative effectiveness of regional versus general anesthesia for hip fracture surgery in adults. In: Anesthesiology. 2012 ; Vol. 117, No. 1. pp. 72-92.
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