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Abstract
Background There is a lack of consensus in the literature as to whether anesthetic modality influences perioperative complications in hip fracture surgery. The aim of the present study was to assess the effect of spinal anesthesia compared with general anesthesia on postoperative morbidity and mortality in patients who underwent hip fracture surgery using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP).
Methods We used the ACS NSQIP to identify patients aged 50 and older who received either spinal or general anesthesia for hip fracture surgery from 2016 to 2019. Propensity-score matching was performed to control for clinically relevant covariates. The primary outcome of interest was the combined incidence of stroke, myocardial infarction (MI) or death within 30 days. Secondary outcomes included 30-day mortality, hospital length of stay and operative time.
Results Among the 40 527 patients aged 50 and over who received either spinal or general anesthesia for hip fracture surgery from 2016 to 2019, 7358 spinal anesthesia cases were matched to general anesthesia cases. General anesthesia was associated with a higher incidence of combined 30-day stroke, MI or death compared with spinal anesthesia (OR 1.219 (95% CI 1.076 to 1.381); p=0.002). General anesthesia was also associated with a higher frequency of 30-day mortality (OR 1.276 (95% CI 1.099 to 1.481); p=0.001) and longer operative time (64.73 vs 60.28 min; p<0.001). Spinal anesthesia had a longer average hospital length of stay (6.29 vs 5.73 days; p=0.001).
Conclusion Our propensity-matched analysis suggests that spinal anesthesia as compared with general anesthesia is associated with lower postoperative morbidity and mortality in patients undergoing hip fracture surgery.
- REGIONAL ANESTHESIA
- Outcome Assessment
- Health Care
- OUTCOMES
Data availability statement
Data may be obtained from a third party and are not publicly available. The data are deidentified participant data from the ACS NSQIP Hip Fracture Targeted PUF. An individual who wants to obtain access to the ACS NSQIP PUF may do so by visiting www.facs.org/quality-programs/acs-nsqip, clicking the “Request PUF” link, and following the steps listed on the PUF request page.
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Data availability statement
Data may be obtained from a third party and are not publicly available. The data are deidentified participant data from the ACS NSQIP Hip Fracture Targeted PUF. An individual who wants to obtain access to the ACS NSQIP PUF may do so by visiting www.facs.org/quality-programs/acs-nsqip, clicking the “Request PUF” link, and following the steps listed on the PUF request page.
Footnotes
Twitter @drrichardboyer, @RobertWhiteMD
Contributors RBB and NS conceived the original study question. ERW, RBB, RSW, RYW, and TRT conceived and designed the study. RBB retrieved and analyzed the data. ERW and RBB directly accessed and verified the underlying data reported in the manuscript. ERW and TRT wrote the manuscript with support from RBB, RSW, RYL, and JML. TRT helped supervise the project. All authors read and approved the final manuscript. TRT is responsible for the overall content as guarantor, accepts full responsibility for the finished work and conduct of the study, had access to the data, and controlled the decision to publish.
Funding This research is supported in part by the National Institute on Aging, a component of the National Institutes of Health (NIH), through grant number 5R03AG074070-02. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. Dr. White is the recipient of FAER Grant ID MRTG-08-15-2021-White (Robert).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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