Comparison of Peripheral Nerve Block and Spinal Anesthesia in Terms of Postoperative Mortality and Walking Ability in Elderly Hip Fracture Patients – A Retrospective, Propensity-Score Matched Study

Figures & data

Table 1 Demographic Data

Items	Before PSM			After PSM
	SA Group (n=200)	PNB Group (n=116)	P value	SA Group (n=89)	PNB Group (n=89)	P value
Age (years)	76.5±1.1	81.1±1.4	<0.001	77.3±1.7	79.9±1.6	0.105
Gender (male, %)	53 (26.5%)	21 (18.1%)	0.089	15 (16.9%)	18 (20.2%)	0.563
CCI (≤4, %)	132 (66.0%)	49 (42.2%)	<0.001	37 (41.6%)	44 (49.4%)	0.292
Marriage (with spouse, %)	148 (74.0%)	73 (62.9%)	0.039	62 (69.7%)	60 (67.4%)	0.747
Smoking history (no, %)	199 (99.5%)	112 (96.6%)	0.043	88 (98.9%)	88 (98.9%)	1.000
Resident (downtown, %)	164 (82.0%)	98 (84.5%)	0.572	70 (78.7%)	76 (85.4%)	0.242
Medical insurance (no, %)	83 (41.5%)	42 (36.2%)	0.354	36 (40.4%)	31 (34.8%)	0.439
Surgery (THA, %)	94 (47.0%)	20 (17.2%)	<0.001	17 (19.1%)	17 (19.1%)	1.000
Anti-osteoporosis treatment (no, %)	23 (11.5%)	35 (30.2%)	<0.001	16 (18.0%)	17 (19.1%)	0.847
Fragility fractures (no, %)	188 (94.0%)	108 (93.1%)	0.752	85 (95.5%)	83 (93.3%)	0.515
Time from injuries to surgery (days)	7 (5, 15)	8 (6, 15)	0.143	7 (5, 12)	9 (6, 15)	0.051
Baseline GLU (mmol/L)	6.26±0.31	6.67±0.46	0.128	6.57±0.42	6.30±0.50	0.421
Baseline HGB (g/L)	114.90±2.55	116.96±3.20	0.328	116.68±3.89	116.52±3.72	0.954
Baseline ALB (g/L)	33.63±0.60	33.35±0.77	0.574	33.73±0.83	33.26±0.93	0.451
Baseline INR	1.17±0.03	1.24±0.27	0.108	1.08±0.05	1.08±0.03	0.889
Baseline vital signs (normal, %)	145 (72.5%)	72 (62.1%)	0.054	58 (65.2%)	54 (60.7%)	0.535
Electrocardiograph (normal, %)	75 (37.5%)	43 (37.1%)	0.939	33 (37.1%)	31 (34.8%)	0.755
Chest radiography (normal, %)	43 (21.5%)	23 (19.8%)	0.724	18 (20.2%)	14 (15.7%)	0.435

Table 2 Details of Anti-Osteoporosis Treatment Before Fractures

Items	n	%
Standardized anti-osteoporosis therapy	58	18.4%
Calcium + vitamin D + zoledronic acid	22	7.0%
Calcium + vitamin D + alendronate	17	5.4%
Calcium + vitamin D + teriparatide	13	4.1%
Calcium + vitamin D + XianLingGuBao	6	1.9%
Non-standardized anti-osteoporosis therapy	47	14.8%
Irregular medication usage	33	10.4%
Calcium only	14	4.4%
Without anti-osteoporosis treatment	211	66.8%

Figure 1 Flowchart of the present study.

Table 3 Comparison of 30-Day, 90-Day, and One-Year Mortality (n, %)

	SA Group (n=89)	PNB (n=89)	OR (95% CI)	P value
30-day mortality	9 (10.1%)	2 (2.2%)	4.50 (1.00–20.24)	0.029
90-day mortality	11 (12.4%)	3 (3.4%)	3.67 (1.06–12.70)	0.026
One-year mortality	15 (16.9%)	10 (11.2%)	1.50 (0.71–3.16)	0.281

Table 4 Causes of One-Year Mortality

Causes	SA GRoup (n=89)		PNB Group (n=89)
	n	%	n	%
Malignant tumor	2	13.3	2	20.0
Pulmonary infection	1	6.7	1	10.0
Kidney failure	2	13.3	0	0.0
Cardio-cerebral vascular accidents	6	40.0	3	30.0
Natural death	1	6.7	2	20.0
Pulmonary embolism	1	6.7	0	0.0
Undetermined	2	13.3	2	20.0
Total	15	100	10	100

Figure 2 Cumulative postoperative mortality over time. The Y axis represents mortality expressed as a percentage of all cases. The X axis represents the number of postoperative months. The blue curve corresponds to patients who underwent spinal anesthesia, while the red curve corresponds to those who underwent peripheral nerve block.

Table 5 Comparison of the Secondary Outcomes in the 1st Postoperative Year

Items	SA Group (n=89)	PNB Group (n=89)	P value
Independent walking (n, %)	72 (80.9%)	63 (70.8%)	0.115
Complications (n, %)	7 (7.9%)	9 (10.1%)	0.600
Pulmonary infection (n, %)	4 (57.1%)	4 (44.4%)
DVT/PE (n, %)	1 (14.3%)	3 (33.3%)
Prosthesis dislocation (n, %)	0 (0)	2 (22.2%)
Prosthetic joint infection (n, %)	2 (28.6%)	0 (0)
Hospital stays (days)	12.3±1.3	11.8±1.3	0.569
Hospitalization costs (CNY)	53,828.21±2552.48	59,278.83±4008.94	0.024