Mode of anesthesia, mortality and outcome in geriatric patients

Abstract

Background: In older non-cardiac surgery patients, the influence of the mode of anesthesia on late-term outcome (rehabilitation, mobility, independence) is a controversial issue in the medical literature. In light of an aging society, this review assessed the association between regional (RA), local (LA) and general anesthesia (GA) and mortality and morbidity.

Methods: A literature search within the PubMed and Cochrane databases yielded 47 clinical trials and 35 reviews/meta-analyses published between 1965 and 2013. Potential outcome-influencing factors such as mortality, risk factors, early complications (e.g. postoperative confusion, aspiration, vomiting), adverse events (e.g. deep vein thrombosis, pulmonary embolism), discharge, rehabilitation and mobilization were evaluated in relation to the mode of anesthesia (RA, LA or GA).

Results: The current literature contains 82 references covering 74,476 non-cardiac surgery patients. Analysis shows that the particular mode of anesthesia influences mortality and morbidity. RA is associated with reduced early mortality and morbidity, e.g. fewer incidents of deep vein thrombosis and less acute postoperative confusion, as well as a tendency toward fewer myocardial infarctions and fatal pulmonary embolisms. GA has the advantages of a lower incidence of hypotension and reduced surgery time.

Conclusion: Strictly speaking, true anesthesia-related complications appear to be rare and many adverse outcomes may be multifactorial. Postoperative complications are largely related to the perioperative procedure and not to the anesthesia itself. GA and RA are both useful for older non-cardiac patients, but for some procedures, e.g. hip fracture surgery, RA seems to be the technique of choice. The mode of anesthesia may only play a secondary role in mobility, rehabilitation and discharge destination. In general, due to the many different possible outcomes--which are often very difficult or impossible to compare--no other specific recommendations can be made with regard to the type of anesthesia to be preferred for older non-cardiac patients.