Older patients undergoing hip fracture surgery have a greater risk of developing post-surgery pneumonia if they receive general anaesthesia rather than a spinal block during the procedure, according to a study presented here at the 2018 Annual Meeting of the American Geriatrics Society (AGS).
Of the 66 patients in the study aged 70 years and older who received general anaesthesia for hip fracture surgery, 12% were hospitalised with pneumonia compared with 6% of the 211 patients who were given spinal anaesthesia for the operation (P< .01).
“In elderly patients with hip fracture operated under general anaesthesia, occurrence of pneumonia is more frequent when compared with other modalities of anaesthesia, regardless of their comorbidities, time to surgery and use of aspirin,” said Jorge Ojeda-Jimenez, MD, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Canary Islands, Spain.
“Pneumonia is also more common among persons with swallowing problems and general anaesthesia could play a synergistic role with dysphagia in developing respiratory tract infections,” he added. “We suggest close monitoring of these high-risk patients in order to early diagnose and treat respiratory complications.”
The patients in the study underwent surgery for hip fracture between January 2017 and January 2018. About 70% were women and the average age of the cohort was 82 years. About 18% of the patients had been in institutions before being taken to the hospital for hip fractures. About 58% of the population was able to perform activities of daily living independently; 28% were ambulatory.
The overall mortality of the patients in the study was less than 5%. Aside from a higher risk of developing pneumonia from general anaesthesia, the researchers also said that the risk of pneumonia was 3.9 times higher in patients with dysphagia (P< .01).
“The underlying mechanism of this relationship between general anaesthesia and pneumonia should be explore to clarify possible targets for intervention,” said Dr. Ojeda-Jimenez.
[Presentation title: Choosing Wisely: Perhaps General Anesthesia Is Not The Safest Option for Hip Fracture Elderly Patients. Abstract D170]