Abstract
The superiority of distinct anesthesia methods for geriatric hip fracture surgery remains unclear. We evaluated high mobility group box-1 (HMGB1) and interleukin-6 (IL-6) with three different anesthesia methods in elderly patients undergoing hip fracture surgery. Routine blood test findings, postoperative morbidity, and mortality were assessed as secondary outcome. In total, 176 patients were randomized into desflurane (n = 60), propofol (n = 58), or spinal groups (n = 58) that received desflurane-based balanced anesthesia, propofol-based total intravenous anesthesia (TIVA), or spinal anesthesia, respectively. The spinal group required less intraoperative vasopressors (p < 0.001) and fluids (p = 0.006). No significant differences in HMGB1 (pgroup×time = 0.863) or IL-6 (pgroup×time = 0.575) levels were noted at baseline, postoperative day (POD) 1, or POD2. Hemoglobin, albumin, creatinine, total lymphocyte count, potassium, troponin T, and C-reactive protein were comparable among groups at all time-points. No significant differences in postoperative hospital stay, intensive care unit (ICU) stay, and ventilator use among groups were observed. Postoperative pulmonary, cardiac, and neurologic complications; and in-hospital, 30-day, and 90-day mortality were not significantly different among groups (p = 0.974). In conclusion, HMGB1 and IL-6, and all secondary outcomes, were not significantly different between desflurane anesthesia, propofol TIVA, and spinal anesthesia.
Highlights
Hip fracture is a surgical disease, with more than 95% of patients undergoing operative treatment [1]
Several laboratory tests have been suggested to be predictive of mortality after hip fracture surgery, which include routine blood tests such as hemoglobin (Hb), total lymphocyte count (TLC), albumin, and creatinine [3]; and cytokines such as tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-10 (IL-10) [4]
We focused on high mobility group box-1 (HMGB1), which acts as a damage-associated molecular pattern molecule that mediates the noninfectious inflammatory response, and its significance in traumatic hip fracture surgery
Summary
Hip fracture is a surgical disease, with more than 95% of patients undergoing operative treatment [1]. Two important facets of the surgical management of elderly hip fracture patients are the utility of laboratory tests for predicting outcomes and optimal anesthetic method. The superiority of different methods of anesthesia in terms of clinical outcomes after hip fracture surgery is the focus of many researchers in the field. In this context, we focused on high mobility group box-1 (HMGB1), which acts as a damage-associated molecular pattern molecule that mediates the noninfectious inflammatory response, and its significance in traumatic hip fracture surgery. While studies have reported greater benefit with regional anesthesia over general anesthesia, recent data suggest that clinical outcomes between these anesthetic methods are not significantly different [6]
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