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Comparative Study
. 2019 Sep 9;9(9):e029245.
doi: 10.1136/bmjopen-2019-029245.

Comparison of general anaesthesia and regional anaesthesia in terms of mortality and complications in elderly patients with hip fracture: a nationwide population-based study

Eun Jin Ahn  1 , Hyo Jin Kim  1 , Kyung Woo Kim  1 , Hey Ran Choi  1 , Hyun Kang  2 , Si Ra Bang  3
Affiliations
Comparative Study

Comparison of general anaesthesia and regional anaesthesia in terms of mortality and complications in elderly patients with hip fracture: a nationwide population-based study

Eun Jin Ahn et al. BMJ Open. .

Abstract

Objective: To evaluate the effects of anaesthesia on postoperative outcome in elderly patients who underwent hip fracture surgery.

Setting: Nationwide National Health Insurance Sharing Service database of Korea.

Participants: All patients aged ≥65 years old who underwent hip fracture surgery, covered by the Korean National Health Insurance, between 1 January 2009 and 31 December 2015.

Interventions: Hip fracture surgery under general anaesthesia (group GA) or regional anaesthesia (group RA), with a principal diagnosis of femoral fracture.

Primary and secondary outcome measures: The primary outcome was the anaesthetic-type effect on 30-day mortality and the secondary outcome was postoperative delirium requiring pharmacological intervention.

Results: Among the 96 289 patients who underwent hip fracture surgery, 25 593 and 70 696 patients received GA and RA, respectively. After propensity score matching, 25 593 remained in each group. Postmatching mortality was lower in the RA than in the GA group (574 (2.24%) vs 654 (2.55%), p=0·0047, 95% CI -0.0099 to 0.0159). Delirium incidence was lower in the RA than in the GA group (5187 (20.27%) vs 5828 (22.77%), p<0·0001, 95% CI 0.019 to 0.045). The incidence of intensive care unit stay and ventilator care was lower in the RA than in the GA group (5838 (22.1%) vs 8055 (31.47%), p<0·0001, 95% CI 0.046 to 0.070 and 459 (1.73%) vs 1207 (4.72%), p<0·0001, 95% CI -0.0024 to 0.023, respectively).

Conclusion: RA was associated with better outcomes than GA, in terms of mortality, delirium, intensive care unit admission and ventilator care, in elderly patients who underwent hip fracture surgery.

Keywords: delirium; hip fracture; mortality.

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Conflict of interest statement

Competing interests: The authors declare no conflict of interest with the NHIS.

Figures

Figure 1
Figure 1
Flow diagram of included patient numbers.
See this image and copyright information in PMC

References

    1. YC H, Park YG, Nam KW, et al. Trend in hip fracture incidence and mortality in Korea: a prospective cohort study from 2002 to 2011. J Korean Med Sci 2015;30:483–8. - PMC - PubMed
    1. YC H, Kim TY, Lee A, et al. Current trends and future projections of hip fracture in South Korea using nationwide claims data. Osteoporos Int 2016;27:2603–9. - PubMed
    1. Chu C-C, Weng S-F, Chen K-T, et al. Propensity Score–matched comparison of postoperative adverse outcomes between geriatric patients given a general or a neuraxial anesthetic for hip surgery. Anesthesiology 2015;123:136–47. 10.1097/ALN.0000000000000695 - DOI - PubMed
    1. Inouye SK, Westendorp RGJ, Saczynski JS. Delirium in elderly people. The Lancet 2014;383:911–22. 10.1016/S0140-6736(13)60688-1 - DOI - PMC - PubMed
    1. Seitz DP, Gill SS, Bell CM, et al. Postoperative medical complications associated with anesthesia in older adults with dementia. J Am Geriatr Soc 2014;62:2102–9. 10.1111/jgs.13106 - DOI - PubMed

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