A new study shows that regional anesthesia for hip fracture surgery, advocated as a safer alternative to general anesthesia (GA), did not result in fewer deaths after the procedure.
Researchers at the University of Pennsylvania (Philadelphia, USA) and Columbia University (New York, NY, USA) conducted a matched retrospective cohort study involving 56,729 patients 50 years or older who underwent hip fracture surgery in New York State between 2004 and 2011. In all, 15,904 (28%) received regional (spinal or epidural) anesthesia, and 40,825 (72%) received GA. The main outcome measure was 30 day mortality and hospital length of stay. Overall, 3,032 patients (5.3%) died.
The 30-day mortality rate was 5.4% among patients who lived around centers specializing in spinal or epidural blockade plus sedation, compared with 5.8% for those who resided around centers doing GA for the surgery. A comparison of the two approaches within hospitals using both approaches likewise turned up no significant difference in early survival. But a matched analysis showed 0.6-day's shorter stays among patients near a regional anesthesia-specialized center versus near a GA-specialized center. The study was published in the June 25, 2014, issue of the Journal of the American Medical Association (JAMA).
“Among adults in acute care hospitals in New York State undergoing hip repair, the use of regional anesthesia compared with general anesthesia was not associated with lower 30-day mortality but was associated with a modestly shorter length of stay,” concluded lead author Mark Neuman, MD, of the University of Pennsylvania, and colleagues. “A comparison of the two approaches within hospitals using both likewise turned up no benefit. These findings do not support a mortality benefit for regional anesthesia in this setting.”
Regional anesthesia has remained in the minority for hip fracture procedures, despite a push from practice guidelines calling for broader use of regional anesthesia for hip fracture surgery as a strategy to improve quality of care and cut postoperative complications.
University of Pennsylvania