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

Figures & data

Figure 1 Flowchart showing patient enrollment and analysis.

Abbreviations: GA, general anesthesia; PNBs, peripheral nerve blocks.

Table 1 Comparison of the demographics of 217 elderly patients between the GA and PNBs groups

	Total (n=217)	GA group (n=72)	PNBs group (n=145)	χ^2 or 95% CI	P-value
Female*	151 (69.6%)	51 (70.8%)	100 (69.0%)	0.08	0.778
Age (years)†	79.8±6.6	78.8±5.6	80.1±7.0	−3.16 to −0.56	0.169
Weight (kg)†	58.3±11.4	57.4±9.3	58.8±12.3	−4.60 to 1.86	0.404
Height (cm)†	162.1±7.5	161.9±7.2	161.2±7.7	−2.49 to 1.80	0.751
BMI (kg/m^2)*	22.1±3.5	21.8±2.8	22.8±3.9	148.26	0.455
Operation site (left)*	109 (50.2%)	37 (51.4%)	72 (49.7%)	0.06	0.810
ASA status*				2.60	0.273
2	77 (35.5%)	25 (34.7%)	52 (35.9%)
3	99 (45.6%)	35 (48.6%)	64 (44.1%)
4	41 (18.9%)	12 (16.7%)	29 (20.0%)

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

* χ², test of independence;

† two-tailed Student’s t-test.

Abbreviations: ASA, American Society of Anesthesiologists; BMI, body mass index; CI, confidence interval; GA, general anesthesia; PNBs, peripheral nerve blocks.

Table 2 Intraoperative and postoperative data of the 217 subjects in the GA and PNBs groups

	Total (n=217)	GA group (n=72)	PNBs group (n=145)	χ^2 or 95% CI	P-value
Waiting time to operation (days)†	7.12±4.18	6.83±4.34	7.26±4.11	−1.62 to 0.76	0.478
PLOS (days)†	8.87±4.65	9.25±4.32	8.68±4.81	−7.48 to 1.90	0.393
ICU (frequency)*	38 (17.5%)	9 (12.5%)	29 (20%)	1.87	0.171
Hospital charges (10^3 RMB)†	27.2±28.0	23.6±15.6	28.9±32.3	−1.32 to 2.30	0.194
Duration of operation (minutes)†	105.9±32.4	109±32.3	104.3±32.5	−4.50 to 13.91	0.315
Intraoperative fluid (mL)†	723±230	720±282	723±200	−67.88 to 62.92	0.941
Blood loss (mL)†	424±199	429±199	422±197	−49.17 to 63.17	0.806
Blood transfusion†
Blood plasma (mL)	253±204	220±177	262±219	−100.56 to 16.56	0.159
Red blood cells (U)	3.91±2.40	3.81±2.14	3.98±2.55	−51.10 to 50.76	0.995

Notes: Data are presented as mean ± standard deviation or median;

* χ², test of independence;

† two-tailed Student’s t-test.

Abbreviations: CI, confidence interval; GA, general anesthesia; ICU, intensive care unit; PLOS, postoperative hospital length of stay; PNBs, peripheral nerve blocks; RMB, renmenbi.

Table 3 Preoperative comorbidities, postoperative complications, and mortality of 217 elderly patients in the GA and PNBs groups

	Total (n=217)	GA group n=72)	PNBs group (n=145)	χ^2	P-value
Preoperative comorbidities
Cardiovascular diseases	69 (31.8%)	21 (29.2%)	48 (33.1%)	0.34	0.558
Myocardial infarction	18 (8.3%)	4 (5.6%)	14 (9.7%)	1.06	0.303
Respiratory system diseases	52 (24.0%)	15 (20.8%)	37 (25.5%)	0.15	0.698
Diabetes	51 (23.5%)	16 (22.2%)	35 (24.1%)	0.10	0.754
Stroke	48 (22.1%)	16 (22.2%)	32 (22.1%)	0.00	0.980
Dementia	33 (15.2%)	19 (26.4%)	14 (9.7%)	10.45	0.001
Delirium	38 (17.5%)	15 (20.8%)	23 (15.9%)	0.82	0.364
Renal disease	22 (10.1%)	8 (11.1%)	14 (9.7%)	0.11	0.738
Electrolyte disturbances	23 (10.6%)	9 (12.5%)	14 (9.7%)	0.41	0.522
Hypoxemia	33 (15.2%)	13 (18.1%)	20 (13.8%)	0.68	0.410
Malignancy	27 (12.4%)	8 (11.1%)	19 (13.1%)	0.18	0.675
Number of patients with no comorbidities:	54 (24.9%)	14 (19.4%)	40 (27.6%)	7.26	0.064
1	72 (33.2%)	25 (34.7%)	47 (32.4%)
2	57 (26.3%)	21 (29.2%)	36 (24.8%)
≥3	34 (15.7%)	12 (16.7%)	22 (15.2%)
Postoperative complications
Acute cardiovascular events	55 (25.3%)	18 (25.0%)	37 (25.5%)	0.01	0.934
Myocardial infarction	8 (3.7%)	2 (2.8%)	6 (4.1%)	0.25	0.617
Acute respiratory events	33 (15.2%)	13 (18.1%)	20 (13.8%)	0.68	0.410
Stroke	9 (4.1%)	5 (6.9%)	4 (2.8%)	2.12	0.145
Delirium	50 (23.0%)	18 (25.0%)	32 (22.1%)	0.23	0.629
DVT/PE	11 (5.1%)	5 (6.9%)	6 (4.1%)	0.79	0.375
Renal disorder	37 (17.1%)	11 (15.3%)	26 (17.9%)	0.24	0.625
Electrolyte disturbances	51 (23.5%)	20 (27.8%)	31 (21.4%)	1.10	0.295
Anemia	33 (15.2%)	12 (16.7%)	21 (14.5%)	0.18	0.673
Hypoxemia	42 (19.4%)	19 (26.4%)	23 (15.9%)	3.42	0.065
Deep wound infection	20 (9.2%)	7 (9.7%)	13 (9.0%)	0.03	0.856
Number of complications:	67 (30.9%)	17 (23.6%)	50 (34.5%)	5.10	0.165
1	68 (31.3%)	23 (31.9%)	45 (31.0%)
2	51 (23.5%)	17 (23.6%)	34 (23.5%)
≥3	31 (14.3%)	15 (20.8%)	16 (11.0%)
Postoperative mortality
In-hospital	15 (6.9%)	7 (9.7%)	8 (5.5%)	1.32	0.250
30-day	32 (14.7%)	12 (16.7%)	20 (13.8%)	0.32	0.574
1-year	51 (23.5%)	16 (22.2%)	35 (24.1%)	0.10	0.886

Notes: Data are presented as number (percentage), or ratio or mean ± standard deviation. Cardiovascular diseases include hypertension, coronary artery disease, and arrhythmia; respiratory system diseases include chronic obstructive pulmonary disease, asthma, pulmonary fibrosis, pneumonia, and chronic bronchitis; χ², test of independence.

Abbreviations: DVT/PE, deep vein thrombosis/pulmonary embolus; GA, general anesthesia; PNBs, peripheral nerve blocks.

Table 4 Univariate Cox regression analysis of all variables for mortality at 30 days and 1 year postoperatively: final step

	30-day mortality	1-year mortaily
Male sex	1.8 (1.6 to 2.5)**	1.6 (1.2 to 3.2)**
ICU admission	1.8 (1.2 to 3.8)	1.3 (0.8 to 2.0)
≥85 years	2.8 (1.5 to 5.5)*	3.0 (2.1 to 5.4)*
Preoperative comorbidities
Cardiovascular diseases	1.7 (1.2 to 2.0)	1.3 (1.1 to 1.8)*
Diabetes	1.2 (0.9 to 1.9)	1.4 (1.1 to 1.7)
Respiratory system diseases	2.4 (1.4 to 3.8)*	1.8 (1.2 to 2.8)*
Stroke	1.3 (1.1 to 1.7)	1.1 (0.9 to 1.5)
Dementia	2.2 (1.4 to 4.8)*	2.5 (2.1 to 4.0)
Hypoxia	3.6 (1.5 to 12.4)	1.9 (0.8 to 5.2)
Malignancy	1.2 (1.0 to 2.0)	1.7 (1.4 to 2.9)
Comorbidities ≥3	2.2 (1.5 to 3.2)**	2.5 (2.2 to 3.7)**
ASA ≥ III	2.5 (1.8 to 4.4)**	3.8 (2.6 to 5.8)**
Postoperative complications
Acute cardiovascular events	8.8 (5.0 to 18.9)**	6.0 (3.2 to 10.6)**
Myocardial infarction	10.1 (3.3 to 36.7)**	8.4 (2.0 to 32.5)**
Acute respiratory events	8.5 (6.6 to 13.1)**	5.0 (3.5 to 7.3)**
Stroke	8.8 (4.9 to 18.5)**	5.6 (3.4 to 9.7)*
Delirium	2.0 (1.2 to 4.3)	1.6 (0.9 to 3.4)
DVT/PE	1.9 (1.1 to 4.2)	2.3 (1.7 to 3.6)
Hypoxia	3.6 (1.9 to 8.8)*	2.4 (1.3 to 4.4)
Anemia	0.9 (0.6 to 2.3)	1.6 (0.9 to 2.8)
Deep wound infection	0.5 (0.1 to 4.8)	1.2 (1.0 to 3.5)
≥3 complications	14.5 (8.9 to 19.9)**	7.8 (4.6 to 10.3)**

Notes: Data are hazard ratios (95% confidence intervals);

** P<0.01;

* P<0.05.

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

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

	30-day mortality	1-year mortality
Male sex	1.6 (1.2 to 2.1)*	1.8 (1.5 to 3.8)**
ICU admission	2.0 (1.3 to 4.2)	1.3 (0.9 to 2.4)
≥85 years	1.8 (1.2 to 4.0)*	2.2 (1.5 to 4.6)*
Preoperative comorbidities
Cardiovascular diseases	0.9 (0.7 to 1.3)	1.2 (0.9 to 2.1)
Diabetes	1.1 (0.8 to 1.7)	1.2 (1.0 to 1.7)
Respiratory system diseases	2.4 (1.5 to 3.8)*	1.8 (1.2 to 3.3)*
Stroke	1.2 (0.9 to 1.9)	1.1 (0.9 to 1.6)
Dementia	2.0 (1.5 to 3.7)	2.2 (1.8 to 4.0)
Hypoxia	2.2 (1.8 to 7.2)*	1.5 (1.2 to 2.6)*
Malignancy	1.3 (1.1 to 2.5)*	1.4 (1.1 to 2.8)**
Postoperative complications
Acute cardiovascular events	5.8 (4.5 to 11.7)**	4.6 (3.0 to 9.8)**
Myocardial infarction	6.2 (2.5 to 9.6)**	3.8 (2.2 to 6.1)**
Acute respiratory events	4.4 (3.2 to 9.0)**	3.5 (3.0 to 6.8)**
Stroke	2.6 (1.3 to 5.5)**	3.0 (2.3 to 6.2)*
Acute renal impairment	1.8 (0.8 to 3.3)	2.0 (1.1 to 3.4)
Hypoxia	3.5 (1.9 to 6.4)	1.8 (1.3 to 2.8)

Notes: Data are hazard ratios (95% confidence intervals);

** P<0.01;

* P<0.05.

Abbreviation: ICU, intensive care unit.