[Ortho] Impact of Anesthesia on Hospital Mortality and Morbidities in Geriatric Patients Following Emergency Hip Fracture Surgery

[Alexander Chelnokov]

Qiu, Chunyuan MD, MS*; Chan, Priscilla H. MS†; Zohman, Gary L. MD‡; 
Prentice, Heather A. PhD, MPH§; Hunt, Jessica J. MA†; LaPlace, Diana C. 
MD*; Nguyen, Vu T. MD*; Diekmann, Glenn R. MD‖; Maletis, Gregory B. MD‖; 
Desai, Vimal MD*

Journal of Orthopaedic Trauma: March 2018 - Volume 32 - Issue 3 - p 116–123

doi: 10.1097/BOT.0000000000001035

Objectives: To determine the impact of anesthesia type on in-hospital 
mortality and morbidity for geriatric fragility hip fracture surgery.

Design: Retrospective cohort study.

Setting: Integrates health care delivery system across 38 facilities in 
the United States.

Patients/Participants: We identified 16,695 patients 65 years of age and 
older who underwent emergent hip fracture repairs between 2009 and 2014 
through the Kaiser Permanente hip fracture registry and excluded 
pathologic or bilateral fractures.

Intervention: Hip fracture surgery with general or regional anesthesia.

Main Outcomes Measures: Data on in-hospital mortality, time to death, 
discharge disposition, and length of stay (LOS) were analyzed among the 
following anesthesia types: general anesthesia (GA), regional anesthesia 
(RA), and intraoperative conversions from regional to general (Cv).

Results: Compared with RA, the hazard ratio for GA for in-hospital 
mortality was 1.38 and 2.23 for the Cv group; the time ratio for 
GA-associated time to death was 0.97 and 0.89 for the Cv group. The 
GA-associated time ratio for LOS before discharge was 1.01, and the 
hazard ratio for home discharge was 0.86, but no significance was found 
with the Cv group.

Conclusions: RA may offer advantages over GA for fragility hip fracture 
surgeries when possible. In-hospital mortality, time to death, increased 
LOS, and discharge to an institute rather than home were all adversely 
influenced by GA. Furthermore, the previously understudied Cv group 
demonstrated adverse outcomes for in-hospital mortality and time to death.

Level of Evidence: Therapeutic Level III. See Instructions for Authors 
for a complete description of levels of evidence.
Alexander Chelnokov