Similar mortality with general or regional anesthesia in elderly hip fracture patients

Figures & data

Table 1. Characteristics of patients who received general, spinal/neuroaxial, and mixed anesthesia for hip fracture surgery, 2009–2012 (n = 7,585). Values are % (n) unless otherwise specified

	Total n = 7,585	General n = 4,257	Spinal/neuroaxial n = 3,059	Mixed n = 269	p-value
Sex					0.2
Female	71.4 (5,412)	70.7 (3,008)	72.5 (2,217)	69.5 (187)
Age, years
Median age (IQR)	80 (72–85)	79 (71–84)	80 (73–85)	79 (71–84)	< 0.001
55–64	10.6 (804)	11.7 (496)	9.0 (274)	12.6 (34)	< 0.001
65–74	20.7 (1,571)	21.4 (912)	19.6 (599)	22.3 (60)
75–89	68.7 (5,210)	66.9 (2,849)	71.5 (2,186)	65.1 (175)
Race ^a					0.08
White	79.8 (6,040)	78.9 (3,349)	80.8 (2,469)	82.5 (222)
Non-white	20.2 (1,526)	21.1 (893)	19.2 (586)	17.5 (47)
BMI ^a
Median BMI (IQR)	23.7 (20.8–27.1)	23.8 (20.8–27.2)	23.5 (20.6–26.8)	23.4 (20.7–26.6)	0.004
< 18.5 (underweight)	9.7 (735)	9.2 (391)	10.2 (311)	12.3 (33)	0.02
18.5–24.9 (normal)	50.5 (3,812)	49.8 (2,111)	51.1 (1,554)	54.9 (147)
25.0–29.9 (overweight)	27.8 (2,099)	28.1 (1,191)	27.9 (849)	22.0 (59)
≥ 30.0 (obese)	12.0 (904)	12.9 (546)	10.8 (329)	10.8 (29)
ASA score ^a
Median score (IQR)	3 (2–3)	3 (2–3)	3 (2–3)	3 (2–3)	0.002
1 or 2	33.7 (2,473)	32.4 (1,270)	35.9 (1,006)	37.3 (90)	0.008
3 or more	66.3 (4,857)	67.5 (2,639)	64.1 (1,795)	62.7 (151)
Comorbidity ^b
Any	93.9 (7,120)	93.8 (3,994)	94.0 (2,875)	93.3 (251)	0.9
Total ^c, median (IQR)	3 (2–4)	3 (2–4)	3 (2–4)	3 (2–4)	0.4
Valvular disease	9.2 (696)	10.3 (439)	7.5 (230)	10.0 (27)	< 0.001
Paralysis	4.7 (353)	5.7 (242)	3.3 (100)	4.1 (11)	< 0.001
Neurological disorders	19.7 (1,496)	21.3 (905)	17.9 (548)	16.0 (43)	< 0.001
Chronic pulmonary disease	22.3 (1,692)	19.5 (829)	25.5 (780)	30.9 (83)	< 0.001
Hypothyroidism	18.2 (1,380)	17.1 (730)	19.7 (604)	17.1 (46)	0.02
Metastatic cancer	2.2 (168)	2.2 (93)	2.1 (64)	4.1 (11)	0.1
Coagulopathy	7.0 (533)	7.6 (322)	6.4 (196)	5.6 (15)	0.1
Chronic blood-loss anemia	4.0 (305)	3.4 (144)	4.9 (149)	4.5 (12)	0.006
Diabetes ^d	22.5 (1,703)	23.0 (977)	22.1 (676)	18.6 (50)	0.2
Procedure					< 0.001
Internal fixation	61.3 (4,653)	63.4 (2,699)	58.4 (1,785)	62.8 (169)
Total hip arthroplasty	3.0 (229)	2.7 (114)	3.3 (101)	5.2 (14)
Hemiarthroplasty	35.2 (2,667)	33.4 (1,422)	38.1 (1,165)	29.7 (80)
Other	0.5 (36)	0.5 (22)	0.3 (8)	2.2 (6)

IQR: interquartile range; BMI: body mass index; ASA: American Society of Anaesthesiologists.

a Missing data: BMI, n = 35 (0.5%); race, n = 23 (0.3%); ASA score, n = 634 (8.4%).

b Identified using the Elixhauser comorbidy index algorithm.

c Total number of Elixhauser comorbidities (i.e. comorbidity burden). Comorbidities included: congestive heart failure, valvular disease, pulmonary circulation disease, peripheral vascular disease, paralysis, neurological disorders, chronic pulmonary disease, diabetes with and/or without chronic complications, hypothyroidism, liver disease, peptic ulcer disease with bleeding, acquired immune deficiency syndrome, lymphoma, metastatic cancer, solid tumor without metastasis, rheumatoid arthritis, coagulopathy, obesity, weight loss, fluid and electrolyte disorders, chronic blood-loss anemia, deficiency anemia, alcohol abuse, drug abuse, psychoses, depression, and hypertension.

d Data reported are from the Kaiser Permanente regional diabetes registries.

Table 2. Mortality in patients who received general, spinal/neuro­axial, and mixed anesthesia for hip fracture surgery, 2009–2012. Values are % (n)

Mortality within	Total n = 7,585	General n = 4,257	Spinal/neuroaxial n = 3,059	Mixed n = 269	p-value
30 days	4 (307)	4 (177)	4 (113)	6 (17)	0.1
90 days	8 (583)	8 (336)	7 (224)	9 (23)	0.6
365 days	15 (1,126)	16 (661)	14 (424)	15 (41)	0.1

Table 3. Odds ratios (OR) for mortality and 95% confidence intervals (CI) for patients who received spinal/neuroaxial anesthesia and mixed anesthesia compared to those who received general anesthesia for hip fracture surgery, 2009–2012 (n = 7,585)

	Unadjusted mortality within			Adjusted ^a mortality within
Anesthesia type	30 days OR (CI)	90 days OR (CI)	365 days OR (CI)	30 days OR (CI)	90 days OR (CI)	365 days OR (CI)
General	Reference	Reference	Reference	Reference	Reference	Reference
Spinal/neuroaxial	0.88 (0.70–1.12)	0.92 (0.77–1.10)	0.88 (0.77–1.00)	0.88 (0.64–1.20)	0.93 (0.74–1.18)	0.84 (0.70–1.00)
Mixed	1.56 (0.93–2.60)	1.09 (0.70–1.70)	0.98 (0.69–1.38)	1.28 (0.70–2.34)	0.91 (0.54–1.53)	0.82 (0.55–1.23)

a Model adjusted for sex, age, race, BMI, ASA score, comorbidities (valvular disease, paralysis, neurological disorders, chronic pulmonary disease, hypothyroidism, metastatic cancer, coagulopthy, chronic blood loss, and anemia).