Abstract
Background: Hip fractures yearly affect 1.6 million patients worldwide, often the elderly with complex comorbidity. Mortality following surgery for acute hip fracture is high. The high mortality rate is multifactorial; high age, comorbidities and complication/deterioration in health following surgery. Whether the anaesthesia technique affects the 30-day mortality rate has been studied widely without reaching a consensus. The primary aim of this study was to determine anaesthetic techniques used in Sweden and their impact on the 30-day mortality rate in the elderly, who underwent acute hip fracture surgery. Other aims were to study the impact of age, gender, ASA class, fracture type and delay in surgery on the 30-day mortality rate. Methods: Data from 13,649 patients ≥50 years old who had undergone acute hip fracture surgery and been reported to Swedish perioperative register (SPOR) between 2016 and 2017 were analysed. Results: The most commonly used anaesthetic technique was neuraxial anaesthesia (NA; 11257, 82%), followed by general anaesthesia (GA; 2190, 16%) and combined general and neuraxial anaesthesia (CA; 202, 1.5%) out of the 13,649 studied. The 30-day mortality rate was 7.7% for the entire cohort; GA 7.8%, NA 7.7% and CA 7.4%. Mortality was higher in elderly patients, those with a high ASA class, pertrochanteric fracture and males. Conclusions: The present study showed that NA is by far the most common anaesthetic technique for acute hip fracture surgery in Sweden. However, the anaesthetic technique used during this type of surgery had no impact on the 30-day mortality rate of patients. Increasing age, ASA class and male gender increased the 30-day mortality.
Highlights
Hip fractures yearly affect 1.6 million patients worldwide and the incidence is raising, often the elderly with comorbidities[1]
neuraxial anaesthesia (NA) was the most common anaesthetic technique used (82.5% of patients), general anaesthesia (GA) was used in 16% and CA in 1.5% of pateints
Mean age was similar between the anaesthetic techniques studied, the proportion of age class 75–84 years and >85 years was higher among NA compared to GA (79 vs 75%; p
Summary
Hip fractures yearly affect 1.6 million patients worldwide and the incidence is raising, often the elderly with comorbidities[1]. Neuraxial techniques (spinal and epidural) have the benefit in avoiding the need for airway management and only minor effects on cerebral function. Hip fractures yearly affect 1.6 million patients worldwide, often the elderly with complex comorbidity. Whether the anaesthesia technique affects the 30-day mortality rate has been studied widely without reaching a consensus. The primary aim of this study was to determine anaesthetic techniques used in Sweden and their impact on the 30-day mortality rate in the elderly, who underwent acute hip fracture surgery. Other aims were to study the impact of age, gender, ASA class, fracture type and delay in surgery on the 30-day mortality rate. Methods: Data from 13,649 patients ≥50 years old who had undergone acute hip fracture surgery and been reported to Swedish perioperative register (SPOR) between 2016 and 2017 were analysed
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