Orthopedic surgeons and anesthesiologists have teamed up to examine which types of anesthesia have the lowest mortality rate and fewest complications.
New Data: Elderly Hip Patients, Anesthesia and Complications
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Secondary#anesthesia#postoperativecomplication#hip
Their study, “Is Anesthesia Technique Associated With a Higher Risk of Mortality or Complications Within 90 Days of Surgery for Geriatric Patients With Hip Fractures?” was published in the June 2018 issue of Clinical Orthopaedics and Related Research.
Chunyuan Qiu, M.D., with the Department of Anesthesiology at the Kaiser Permanente Baldwin Park Medical Center and co-author commented to OTW, “After years of practice, it was more evident that ‘short’ exposure to anesthetics was having long-lasting effects.”
“For example, intraoperative anesthesia management can influence the cancer recurrence, surgical site infection, and cognitive function, etc. We planned study to answer a simple question: Do various anesthesia techniques make a difference in patient’s clinical outcomes with today’s medicine?’”
The authors wrote, “We conducted a retrospective study on geriatric patients (65 years or older) with hip fractures between 2009 and 2014 using the Kaiser Permanente Hip Fracture Registry…The final study sample consisted of 16,695 patients…”
Dr. Qiu told OTW, “We found that different anesthesia techniques have different mortality and morbidity profiles in elderly traumatic hip fracture patients who need emergency surgery, which was not seen before for multiple reasons. Because we were able to systematically analyze a large population, our results shed new light: regional anesthesia has the lowest mortality rate as compared to other techniques such as general anesthesia.”
“Whenever possible, regional anesthesia (neuraxial anesthesia and regional blocks) should be considered as the preferred methods for the elderly fragile hip fracture surgeries. The choice your anesthesiologist makes for your hip fracture patients can influence your surgical outcomes. Therefore, as the leader of the care team, you should participate in the decision-making process.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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