General vs Regional Anesthesia Mortality Rates

Elderly folks wheeled into the emergency room may fare better by avoiding general anesthesia, says new work published in the March 2018 edition of the Journal of Orthopaedic Trauma.

The study is titled, “Impact of Anesthesia on Hospital Mortality and Morbidities in Geriatric Patients Following Emergency Hip Fracture Surgery.”

Chunyuan Qiu, M.D., with the Department of Anesthesiology, Kaiser Permanente, Baldwin Park Medical Center in Baldwin Park, California, co-author on the study, wrote, “We identified 16,695 patients 65 years of age and older who underwent hip fracture repairs between 2009 and 2014 through the Kaiser Permanente hip fracture registry and excluded pathologic or bilateral fractures.”

Dr. Qiu told OTW, “The risk and benefit of different anesthesia techniques have been illusive when using mortality as the end results. As a result, the standards of clinical practice of anesthesia vary greatly from person to person and medical centers to medical centers.”

“We believe this inconsistency is partially responsible for the diverse mortality range we encounter after elderly emergency hip fracture surgery, for example, 90-day mortality rates can have greater than a 5-fold difference, ranging from 5 to 30%.”

“Obviously, clarity for this issue is important not only for anesthesiologists, but also for guidelines and guidance for patient-centered clinical outcomes that are beyond any single healthcare subspecialty such as orthopedic surgery, anesthesiology, internal medicine, etc.”

“We used the data from a well-defined and validated total hip registry with a large sample size. The data is also over the last 10 years and thereby recent. Most importantly, this registry data is all from one a single Integrated Medical Delivery System.”

“This allowed us access to a large number of hip fracture patients, a strong dataset and the ability to match patients well. It enabled us to analyze them in a more robust way. Furthermore, this project is a collaboration of many individuals from different branches and hospitals in our medical system, from clinicians, research scientists, data scientist and statisticians.”

“Mortality profiles differ based on the anesthetics, where general anesthesia has a higher in-hospital mortality rate as compared to that of regional or neuraxial anesthesia. This result is independent from their comorbidities, age, gender, races, or type of the hip surgery.”

“For patients who are viable candidates, regional or neuraxial anesthesia should be considered as the preferred anesthesia technique for elderly emergent hip fracture patients.”

“Patient-centered multidisciplinary teamwork is critically important for the fragile and elderly hip fracture patient, given our growing and aging population. As the leader of the team, the orthopedic surgeon should advocate and coordinate the best practice from all subspecialists involving their patient, including the anesthesiologist.”