Anesthesia Experts

General vs. Regional Anesthesia for Hip Fracture Surgery

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Authors: Chu C-C et al., Anesthesiology 2015 May 8; 123:136

In an observational study, regional anesthesia was associated with lower in-hospital mortality and fewer complications.

When patients undergo hip-fracture repair, they have the option of general anesthesia or regional (spinal or epidural) anesthesia. In comparative studies, neither of these two approaches has emerged as decisively better than the other. In this study, researchers in Taiwan used a national database to compare outcomes with regional anesthesia or general anesthesia in older patients (age, ≥65) who underwent hip-fracture repair between 1997 and 2011.

Through propensity scoring, 52,000 patients who received general anesthesia were matched (by age, sex, comorbidities, and fracture type) with 52,000 patients who received regional anesthesia. Regional anesthesia, compared with general anesthesia, was associated with significantly lower rates of in-hospital death (2.13% vs. 2.62%), stroke (1.38% vs. 1.61%), respiratory failure (0.63% vs. 1.67%), intensive care unit admissions (6.16% vs. 11.03%), and need for mechanical ventilation (1.44% vs 7.70%).

Comment

For older patients who undergo hip fracture surgery, this study suggests that regional anesthesia is associated with lower in-hospital mortality and fewer complications than general anesthesia. Although two other recent hip-fracture studies showed no significant mortality advantage for regional anesthesia, they were smaller and did not consider other complications (NEJM JW Gen Med Aug 15 2014 and BMJ 2014; 348:g4022 and JAMA 2014; 311:2508). However, as in this hip-fracture study, a recent study of patients who underwent elective total hip arthroplasty showed an association between regional anesthesia and fewer perioperative complications (NEJM JW Gen Med Mar 1 2015 and J Bone Joint Surg Am 2015; 97:186).

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