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Association of anesthesia and analgesia with long-term mortality after hip fracture surgery: an analysis of the Australian and New Zealand hip fracture registry
  1. D-Yin Lin1,
  2. Richard Woodman2,
  3. Tarandeep Oberai3,
  4. Brigid Brown1,
  5. Craig Morrison1,
  6. Hidde Kroon4,5 and
  7. Ruurd Jaarsma3
  1. 1Anesthesiology, Flinders Medical Centre, Bedford Park, South Australia, Australia
  2. 2Discipline of Epidemiology and Biostatistics, Flinders University, Bedford Park, South Australia, Australia
  3. 3Orthopedics and Trauma Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia
  4. 4Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
  5. 5Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
  1. Correspondence to Dr D-Yin Lin, Anesthesiology, Flinders Medical Centre, Bedford Park, South Australia, Australia; d-yin.lin{at}sa.gov.au

Abstract

Introduction Hip fractures are a common frailty injury affecting a vulnerable geriatric population. It is debated if anesthetic and analgesic techniques are associated with altered risk for outcomes in hip fracture patients. This study aimed to determine the association of anesthesia and regional analgesia with all cause 12-month mortality and even longer-term mortality after hip fracture surgery in Australia and New Zealand.

Methods Data from the Australian and New Zealand Hip Fracture Registry collected from 2016 to 2018, with a minimum follow-up of 12 months, were reviewed. Anesthesia type and use of regional nerve blocks were investigated. The primary outcome was all cause 12-month mortality.

Results 12-month mortality was 30.6% (n=5410) in a total of 17,635 patients. There was no difference in 12-month mortality between patients who received spinal or general anesthesia (p=0.238). The administration of a combination of general and spinal anesthesia for surgery to repair the fracture was an independent predictor of higher 12-month mortality (unadjusted complete case HR=1.17 (95% CI 1.04 to 1.31); p<0.001). Nerve blocks performed in both the emergency department (ED) and the operating theater (OT) were associated with reduced long-term mortality (median follow-up 21 months) with an unimputed unadjusted HR=0.86 (95% CI 0.77 to 0.96; p=0.043).

Conclusion There was no difference in the association of 12-month mortality between general and spinal anesthesia in patients undergoing hip fracture surgery. However, there was an association with a higher risk of 12-month mortality in patients who received both general and spinal anesthesia for the same surgery. Patients who received a regional nerve block in both the ED and the OT had a lower association of 12-month and longer-term mortality risk. The reasons for these findings remain unknown and should be the subject of further research investigation.

  • lower extremity
  • outcome assessment, health care
  • injections, spinal
  • nerve block
  • regional anesthesia

Data availability statement

Data may be obtained from a third party and are not publicly available. The patient data used in this study were used with permission from the Australian and New Zealand Hip Fracture Registry. Restrictions apply to the availability of this patient information.

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Data availability statement

Data may be obtained from a third party and are not publicly available. The patient data used in this study were used with permission from the Australian and New Zealand Hip Fracture Registry. Restrictions apply to the availability of this patient information.

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Footnotes

  • Twitter @hiddekroon

  • Contributors D-YL: This author conceived and designed the study concept. This author also prepared the drafts, and approved and submitted the final manuscript. RW: This author conceived the study design, analyzed and prepared the data, assisted with writing and preparation of the final manuscript. TO: This author conceived the study design, assisted with writing and preparation of the final manuscript. BB: This author conceived the study design, assisted with writing and preparation of the final manuscript. CM: This author conceived the study design, assisted with writing and preparation of the final manuscript. HK: This author conceived and assisted with designing the study, critically revized the drafts, and approved the final manuscript. RJ: This author conceived and assisted with designing the study, has access approval for the utilised database, realised the study, provided departmental support, revised the drafts, and approved the final manuscript. DL and RJ are responsible for the overall content as the guarantors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.