Mode of anesthesia is not associated with outcomes following emergency hip fracture surgery: a population-level cohort study
Background Hip fractures often occur in frail patients with several comorbidities. In those undergoing emergency surgery, determining the optimal anesthesia modality may be challenging, with equipoise concerning outcomes following either spinal or general anesthesia. In this study, we investigated t...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2022-09-01
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| Series: | Trauma Surgery & Acute Care Open |
| Online Access: | https://tsaco.bmj.com/content/7/1/e000957.full |
| _version_ | 1811206438320603136 |
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| author | Carol J Peden Shahin Mohseni Ahmad Mohammad Ismail Maximilian Peter Forssten Gary Alan Bass Dhanisha Jayesh Trivedi Lovisa Ekestubbe Ioannis Ioannidis Caoimhe C Duffy |
| author_facet | Carol J Peden Shahin Mohseni Ahmad Mohammad Ismail Maximilian Peter Forssten Gary Alan Bass Dhanisha Jayesh Trivedi Lovisa Ekestubbe Ioannis Ioannidis Caoimhe C Duffy |
| author_sort | Carol J Peden |
| collection | DOAJ |
| description | Background Hip fractures often occur in frail patients with several comorbidities. In those undergoing emergency surgery, determining the optimal anesthesia modality may be challenging, with equipoise concerning outcomes following either spinal or general anesthesia. In this study, we investigated the association between mode of anesthesia and postoperative morbidity and mortality with subgroup analyses.Methods This is a retrospective study using all consecutive adult patients who underwent emergency hip fracture surgery in Orebro County, Sweden, between 2013 and 2017. Patients were extracted from the Swedish National Hip Fracture Registry, and their electronic medical records were reviewed. The association between the type of anesthesia and 30-day and 90-day postoperative mortality, as well as in-hospital severe complications (Clavien-Dindo classification ≥3a), was analyzed using Poisson regression models with robust SEs, while the association with 1-year mortality was analyzed using Cox proportional hazards models. All analyses were adjusted for potential confounders.Results A total of 2437 hip fracture cases were included in the study, of whom 60% received spinal anesthesia. There was no statistically significant difference in the risk of 30-day postoperative mortality (adjusted incident rate ratio (IRR) (95% CI): 0.99 (0.72 to 1.36), p=0.952), 90-day postoperative mortality (adjusted IRR (95% CI): 0.88 (0.70 to 1.11), p=0.281), 1-year postoperative mortality (adjusted HR (95% CI): 0.98 (0.83 to 1.15), p=0.773), or in-hospital severe complications (adjusted IRR (95% CI): 1.24 (0.85 to 1.82), p=0.273), when comparing general and spinal anesthesia.Conclusions Mode of anesthesia during emergency hip fracture surgery was not associated with an increased risk of postoperative mortality or in-hospital severe complications in the study population or any of the investigated subgroups.Level of evidence: Therapeutic/Care Management, level III |
| first_indexed | 2024-04-12T03:47:44Z |
| format | Article |
| id | doaj.art-86ebb7a0618943c1ad094eb29ec6c3ec |
| institution | Directory Open Access Journal |
| issn | 2397-5776 |
| language | English |
| last_indexed | 2024-04-12T03:47:44Z |
| publishDate | 2022-09-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Trauma Surgery & Acute Care Open |
| spelling | doaj.art-86ebb7a0618943c1ad094eb29ec6c3ec2022-12-22T03:49:04ZengBMJ Publishing GroupTrauma Surgery & Acute Care Open2397-57762022-09-017110.1136/tsaco-2022-000957Mode of anesthesia is not associated with outcomes following emergency hip fracture surgery: a population-level cohort studyCarol J Peden0Shahin Mohseni1Ahmad Mohammad Ismail2Maximilian Peter Forssten3Gary Alan Bass4Dhanisha Jayesh Trivedi5Lovisa Ekestubbe6Ioannis Ioannidis7Caoimhe C Duffy8Department of Clinical Anesthesiology, University of Southern California Keck School of Medicine, Los Angeles, California, USASchool of Medical Sciences, Orebro University, Orebro, SwedenDepartment of Orthopedic Surgery, Orebro University Hospital, Orebro, SwedenDepartment of Orthopedic Surgery, Orebro University Hospital, Orebro, SwedenDivision of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USASchool of Medical Sciences, Orebro University, Orebro, SwedenDivision of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital, Orebro, SwedenDepartment of Orthopedic Surgery, Orebro University Hospital, Orebro, SwedenPerelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USABackground Hip fractures often occur in frail patients with several comorbidities. In those undergoing emergency surgery, determining the optimal anesthesia modality may be challenging, with equipoise concerning outcomes following either spinal or general anesthesia. In this study, we investigated the association between mode of anesthesia and postoperative morbidity and mortality with subgroup analyses.Methods This is a retrospective study using all consecutive adult patients who underwent emergency hip fracture surgery in Orebro County, Sweden, between 2013 and 2017. Patients were extracted from the Swedish National Hip Fracture Registry, and their electronic medical records were reviewed. The association between the type of anesthesia and 30-day and 90-day postoperative mortality, as well as in-hospital severe complications (Clavien-Dindo classification ≥3a), was analyzed using Poisson regression models with robust SEs, while the association with 1-year mortality was analyzed using Cox proportional hazards models. All analyses were adjusted for potential confounders.Results A total of 2437 hip fracture cases were included in the study, of whom 60% received spinal anesthesia. There was no statistically significant difference in the risk of 30-day postoperative mortality (adjusted incident rate ratio (IRR) (95% CI): 0.99 (0.72 to 1.36), p=0.952), 90-day postoperative mortality (adjusted IRR (95% CI): 0.88 (0.70 to 1.11), p=0.281), 1-year postoperative mortality (adjusted HR (95% CI): 0.98 (0.83 to 1.15), p=0.773), or in-hospital severe complications (adjusted IRR (95% CI): 1.24 (0.85 to 1.82), p=0.273), when comparing general and spinal anesthesia.Conclusions Mode of anesthesia during emergency hip fracture surgery was not associated with an increased risk of postoperative mortality or in-hospital severe complications in the study population or any of the investigated subgroups.Level of evidence: Therapeutic/Care Management, level IIIhttps://tsaco.bmj.com/content/7/1/e000957.full |
| spellingShingle | Carol J Peden Shahin Mohseni Ahmad Mohammad Ismail Maximilian Peter Forssten Gary Alan Bass Dhanisha Jayesh Trivedi Lovisa Ekestubbe Ioannis Ioannidis Caoimhe C Duffy Mode of anesthesia is not associated with outcomes following emergency hip fracture surgery: a population-level cohort study Trauma Surgery & Acute Care Open |
| title | Mode of anesthesia is not associated with outcomes following emergency hip fracture surgery: a population-level cohort study |
| title_full | Mode of anesthesia is not associated with outcomes following emergency hip fracture surgery: a population-level cohort study |
| title_fullStr | Mode of anesthesia is not associated with outcomes following emergency hip fracture surgery: a population-level cohort study |
| title_full_unstemmed | Mode of anesthesia is not associated with outcomes following emergency hip fracture surgery: a population-level cohort study |
| title_short | Mode of anesthesia is not associated with outcomes following emergency hip fracture surgery: a population-level cohort study |
| title_sort | mode of anesthesia is not associated with outcomes following emergency hip fracture surgery a population level cohort study |
| url | https://tsaco.bmj.com/content/7/1/e000957.full |
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