Retrospective comparison of the effects of epidural anesthesia versus peripheral nerve block on postoperative outcomes in elderly Chinese patients with femoral neck fractures

Figures & data

Figure 1 Flow chart showing patient enrolment and analysis.

Abbreviations: EA, epidural anesthesia; PNB, peripheral nerve block; FNF, femoral neck fracture.

Table 1 Comparison of demographics for 258 elderly patients receiving epidural anesthesia or PNB

	Total (n=258)	EA group (n=113)	PNB group (n=145)	χ^2	P-value	95% CI
Male sex*	73 (28.3%)	28 (24.8%)	45 (31.0%)	1.225	0.330
Age (years)†	79.7±6.8	78.8±6.5	80.1±7.0		0.129	−2.980, −0.385
Weight (kg)†	58.8±11.7	58.9±10.9	58.8±12.3		0.921	−3.032, −2.741
Height (cm)†	161.9±7.5	161.4±7.3	162.2±7.7		0.399	−1.065, −2.665
BMI (kg/m^2)*	22.27±3.54	22.57±3.65	22.22±3.75		0.448	−1.269, −0.563
Surgical site (left)*	133 (51.6%)	61 (54.0%)	72 (49.7%)	0.476	0.490
ASA status*				1.557	0.459
II	97 (37.6%)	45 (39.8%)	52 (35.9%)
III	116 (45.0%)	52 (46.0%)	64 (44.1%)
≥IV	45 (17.4%)	16 (14.2%)	29 (20.0%)

Notes: Data are presented as the number (percentage), ratio, or mean ± standard deviation.

* Chi-square test;

† two-tailed Student’s t-test.

Abbreviations: BMI, body mass index; CI, confidence interval; EA, epidural anesthesia; ASA, American Society of Anesthesiologists; PNB, peripheral nerve block.

Table 2 Intraoperative and postoperative data for 258 elderly patients receiving epidural anesthesia or PNB

	Total (n=258)	EA group (n=113)	PNB group (n=145)	χ^2	P-value	95% CI
Waiting time to operation (days)†	7.04±3.98	6.76±3.81	7.26±4.11		0.317	−0.482, −1.484
Postoperative LOS (days)†	9.55±9.45	9.95±10.55	9.25±8.53		0.557	−3.038, −1.641
ICU admission*	49 (14.8%)	11 (9.7%)	29 (20%)	5.109	0.024
Costs (10^3 RMB)†	26.9±23.6	24.4±20.4	28.8±25.7		0.137	−0.141, −1.022
Duration of surgery (minutes)†	103±30	100±27	104±33		0.275	−3.332, −11.649
Intraoperative fluids (mL)†	708±198	691±190	723±200		0.192	−16.23, −80.48
Blood loss (mL)†	404±185	382±170	422±194		0.084	−5.474, −85.60
Intraoperatively	240±135	227±127	250±140		0.169	−9.927, −56.496
Postoperatively	164±111	155±103	172±118		0.231	−10.719, −44.276
Blood transfusion (SAGM)†
Blood plasma	247±257	228±298	260±222		0.319	−31.376, −95.86
Red blood cells	4.05±2.90	4.19±3.21	3.94±2.64		0.501	−0.963, −0.472

Notes: Data are presented as number (percentage), or ratio or mean ± standard deviation.

* Chi-square;

† two-tailed Student’s t-test.

Abbreviations: CI, confidence interval; EA, epidural anesthesia; PNB, peripheral nerve block; ICU, intensive care unit; LOS, length of stay; SAGM, modified saline-adenine-glucose.

Table 3 Preoperative comorbidity, postoperative complications and mortality of 258 elderly patients in EA and PNB groups

	Total (n=258)	EA group (n=113)	PNB group (n=145)	χ^2	P-value
Preoperative comorbidities
Cardiovascular disease	78 (30.2%)	30 (26.5%)	48 (33.1%)	1.294	0.255
Myocardial infarction	23 (8.9%)	9 (8.0%)	14 (9.7%)	0.224	0.636
Respiratory disease	60 (23.3%)	23 (20.4%)	37 (25.5%)	0.949	0.330
Diabetes	60 (23.3%)	25 (22.1%)	35 (24.1%)	0.144	0.704
Stroke	56 (21.7%)	24 (21.2%)	32 (22.1%)	0.026	0.873
Dementia	17 (6.6%)	3 (2.7%)	14 (9.7%)	5.056	0.025
Delirium	33 (12.8%)	10 (8.8%)	23 (15.9%)	4.198	0.041
Renal disease	28 (10.8%)	14 (12.4%)	14 (9.7%)	0.491	0.484
Electrolyte disturbances	24 (9.3%)	10 (8.8%)	14 (9.7%)	0.049	0.825
Hypoxemia	38 (14.7%)	18 (15.9%)	20 (13.8%)	0.231	0.631
Malignancy	30 (11.6%)	11 (9.7%)	19 (13.1%)	0.701	0.402
Comorbidities (n)	72 (27.9%)	32 (28.3%)	40 (27.6%)	6.181	0.103
1	84 (32.6%)	37 (32.7%)	47 (32.4%)
2	61 (23.6%)	25 (22.1%)	36 (24.8%)
≥3	41 (15.9%)	19 (16.8%)	22 (15.2%)
Postoperative complications
Acute cardiovascular events	61 (23.6%)	24 (21.2%)	37 (25.5%)	0.644	0.422
Myocardial infarction	9 (3.5%)	3 (2.7%)	6 (4.1%)	0.415	0.520
Acute respiratory events	27 (10.5%)	7 (6.2%)	20 (13.8%)	3.913	0.048
Stroke	20 (7.8%)	11 (9.7%)	4 (2.8%)	5.644	0.018
Delirium	45 (17.4%)	13 (11.5%)	32 (22.1%)	4.922	0.027
DVT/PE	12 (4.7%)	6 (5.3%)	6 (4.1%)	0.197	0.658
Renal disorder	46 (17.8%)	20 (17.7%)	26 (17.9%)	0.002	0.962
Electrolyte disturbances	54 (20.9%)	23 (20.4%)	31 (21.4%)	0.040	0.841
Anemia	38 (14.7%)	17 (15.0%)	21 (14.5%)	0.016	0.900
Hypoxemia	47 (18.2%)	24 (21.2%)	23 (15.9%)	1.232	0.267
Deep wound infection	25 (9.7%)	12 (10.6%)	13 (9.0%)	0.199	0.656
Complications (n)	97 (37.6%)	43 (38.1%)	54 (37.2%)	0.239	0.971
1	77 (29.8%)	32 (28.3%)	45 (31.0%)
2	62 (24.0%)	28 (24.8%)	34 (23.5%)
≥3	22 (8.5%)	10 (8.8%)	12 (8.3%)
Postoperative mortality
In-hospital	11 (4.3%)	3 (2.7%)	8 (5.5%)	0.6699	0.4131
30-day	32 (12.4%)	12 (10.6%)	20 (13.8%)	0.5887	0.4429
1-year	59 (22.9%)	24 (21.2%)	35 (24.1%)	0.3026	0.5823

Notes: Data are presented as number (percentage), ratio, or mean ± standard deviation. Cardiovascular disease includes hypertension, coronary artery disease, and arrhythmia; respiratory disease includes chronic obstructive pulmonary disease, asthma, pulmonary fibrosis, pneumonia, and chronic bronchitis. Differences in complication rates between the two groups were tested using chi-square statistics.

Abbreviations: EA, epidural anesthesia; PNB, peripheral nerve block; DVT/PE, deep vein thrombosis/pulmonary embolus.

Table 4 Univariate Cox regression analysis of the variables for 30-day and 1-year mortality

	30-day mortality	1-year mortality
Male sex	1.8 (1.5–2.4)**	1.5 (1.4–3.0)**
ICU admission	1.9 (1.2–4.2)	1.3 (0.7–2.1)
Age ≥85 years	2.7 (1.4–5.2)*	3.1 (2.2–5.3)*
Preoperative comorbidities
Cardiovascular disease	1.6 (1.2–1.9)	1.3 (1.1–1.8)*
Diabetes	1.2 (0.9–1.8)	1.4 (1.2–1.7)*
Respiratory disease	1.9 (1.3–2.4)**	1.6 (1.2–1.8)*
Stroke	1.2 (1.1–1.7)	1.1 (0.9–1.4)
Dementia	2.0 (1.4–4.7)*	2.5 (2.2–3.8)
Renal disease	1.8 (1.3–4.0)	2.2 (1.5–4.4)*
Hypoxia	3.3 (0.8–13.2)	1.8 (0.6–5.4)
Malignancy	1.3 (1.0–2.1)	1.6 (1.3–2.6)*
Comorbidities ≥3	2.1 (1.7–3.0)	2.5 (2.0–3.6)
ASA ≥3	2.3 (1.9–3.4)**	3.6 (2.6–5.0)**
Postoperative complications
Acute cardiovascular events	8.1 (5.2–18.3)**	6.5 (3.1–11.0)**
Myocardial infarction	11.0 (2.3–56.7)**	10.4 (2.0–56.1)**
Acute respiratory events	7.5 (6.2–11.0)**	5.1 (4.3–6.2)**
Stroke	8.6 (4.6–17.0)**	5.5 (3.3–8.4)*
Delirium	1.8 (0.9–4.06)	1.8 (0.9–4.2)
DVT/PE	2.1 (1.1–4.6)	2.6 (1.7–3.8)
Hypoxia	2.8 (0.9–8.8)*	2.0 (0.8–4.6)
Anemia	0.9 (0.4–2.5)	1.8 (0.9–3.8)
Deep wound infection	0.4 (0–5.7)	1.1 (1.3–3.4)
≥3 complications	13.8 (8.7–18.5)**	6.8 (5.9–8.5)**

Notes: Figures are hazard ratios (95% confidence intervals).

* P<0.05;

** P<0.01.

Abbreviations: ASA, American Society of Anesthesiologists; ICU, intensive care unit; DVT/PE, deep vein thrombosis/pulmonary embolus.

Table 5 Multivariate Cox regression analysis of the variables for 30-day and 1-year mortality

	30-day mortality	1-year mortality
Male sex	1.5 (1.1–2.0)*	1.8 (1.6–3.5)**
ICU admission	1.8 (1.1–4.1)	1.3 (0.8–2.3)
Age ≥85 years	1.7 (1.2–3.8)	2.1 (1.6–4.3)
Preoperative comorbidities
Cardiovascular disease	0.8 (0.7–1.2)	1.1 (0.9–1.8)
Diabetes	1.0 (0.8–1.6)	1.3 (1.1–1.7)*
Respiratory disease	2.2 (1.7–3.2)*	1.7 (1.2–2.8)*
Stroke	1.0 (0.9–1.8)	1.1 (0.9–1.5)
Dementia	1.8 (1.3–3.7)	2.2 (2.0–3.8)
Renal disease	1.6 (1.3–3.0)*	1.4 (1.1–3.4)*
Hypoxia	2.8 (1.8–7.4)	1.3 (0.6–2.4)
Malignancy	1.3 (1.1–2.3)*	1.5 (1.2–2.8)**
Postoperative complications
Acute cardiovascular events	6.2 (5.0–11.2)**	4.4 (3.1–9.3)**
Myocardial infarction	4.0 (2.5–6.6)**	3.4 (2.0–4.1)**
Acute respiratory events	4.0 (3.6–9.2)**	3.8 (3.0–6.7)**
Stroke	1.6 (1.2–5.3)**	2.5 (2.1–5.4)*
Acute renal impairment	2.0 (0.8–3.6)	2.1 (1.1–3.8)
Hypoxia	2.5 (0.9–4.8)	1.8 (1.1–2.6)

Notes: Figures are hazard ratios (95% confidence intervals).

* P<0.05;

** P<0.01.

Abbreviation: ICU, intensive care unit.