Comparative outcomes of peripheral nerve blocks versus general anesthesia for hip fractures in geriatric Chinese patients

Abstract

Background

Geriatric patients undergoing hemiarthroplasty for hip fractures have unacceptably high rates of postoperative complications and mortality. Whether anesthesia type can affect the outcomes has still been inconclusive.

Objectives

We compared general anesthesia (GA) and peripheral nerve blocks (PNBs) on postoperative complications and mortality in elderly patients with femoral neck fractures (FNF) undergoing hemiarthroplasty.

Materials and methods

This retrospective study involved data collection from an electronic database. Two hundred and seventeen patients underwent hemiarthroplasty for FNF between January 2008 and December 2012 at the Chinese People’s Liberation Army General Hospital. Data on mortality within in-hospital, 30-day, and 1-year, complications, comorbidities, blood loss and transfusion, operative time, postoperative hospital length of stay, intensive care unit admission, and hospital charge were collected and analyzed. Univariate and multivariate Cox regression analyses of all variables were used for 30-day and 1-year mortality.

Results

Seventy-two patients receiving GA and 145 receiving PNBs were eventually submitted and analyzed. Mortality was 6.9%, 14.7%, and 23.5% at in-hospital, 30-day, and 1-year, respectively postoperatively, while mortality and cardiovascular complications did not differ between the two anesthetic techniques. Preoperative comorbidities and intraoperative parameters were not statistically different except that patients receiving GA were more likely to have dementia (χ²=10.45, P=0.001). The most common complications were acute cardiovascular events, electrolyte disturbances, and delirium. Postoperative acute respiratory events and hypoxemia both were also common, but no differences were found between groups (χ²=0.68, P=0.410; χ²=3.42, P=0.065, respectively). Key factors negatively influencing mortality included: age, male gender, American Society of Anesthesiologists status, dementia, perioperative cardiovascular events and respiratory events, postoperative stroke, myocardial infarction, and hypoxia.

Conclusion

Mortality and postoperative complications are not statistically significantly different between PNBs and GA among eldery patients undergoing hemiarthroplasty for FNF.

Keywords:

• femoral neck fractures
• elderly
• mortality
• postoperative complications

Acknowledgments

The authors thank the many research staff involved in this study, especially, Pei Fu Tang, Professor and Director, Department of Orthopaedics, Chinese People’s Liberation Army General Hospital, Beijing, People’s Republic of China; Qun Zhang, Associate Professor, Department of Orthopaedics, Chinese People’s Liberation Army General Hospital, Beijing, People’s Republic of China. We also thank Zhi Li (Shanxi Medical University, Taiyuan, People’s Republic of China) for his assistance in statistical analysis.

Author contributions

JL Liu carried out the literature search and wrote the manuscript; XL Wang acquired the data, carried out statistical analysis, and followed up the subjects; MW Gong collected the data and drafted the manuscript; and HX Mai carried out statistical analysis and revising the manuscript critically for important intellectual content; WX Yuan was involved in designing the research and writing the manuscript; while SJ Pei was involved in interpreting data, critical revision, and followed up the subjects. H Zhang was responsible for the conception and management of the study and audited the study design, edited the manuscript, and acted as guarantor. All co-authors approved the version to be published finally and were accountable for the accuracy or integrity of the work.

Disclosure

The authors report no conflicts of interest in this work.