nach oben

Archives of Orthopaedic and Trauma Surgery

Erschienen in:

15.04.2023 | Orthopaedic Surgery

Postoperative complications of spinal vs general anesthesia in elderly patients undergoing hip hemiarthroplasty

verfasst von: Ashish R. Chowdary, Jack Beale, Jack Martinez, Vikram Aggarwal, Varatharaj Mounasamy, Senthil Sambandam

Erschienen in: Archives of Orthopaedic and Trauma Surgery | Ausgabe 9/2023

Einloggen, um Zugang zu erhalten

Abstract

Introduction

Elderly patients with hip fractures are at high risk for mortality due to postsurgical complications. Hip hemiarthroplasty is a routine procedure done in elderly patients for surgical repair of femoral neck fractures. Both general and spinal anesthesia can be used in elderly patients undergoing hemiarthroplasty. Rates of postoperative complications among the two anesthetic choices have not been directly compared. In this study, we compare the rates of postoperative complications in elderly patients (age greater than 70) undergoing hip hemiarthroplasty for femoral neck fractures using a national database.

Methods

Data for the years 2015–2020 from the National Surgical Quality Improvement Program (NSQIP) were used for the study. Patients greater than 70 years of age who received a hip hemiarthroplasty with general anesthesia or spinal anesthesia were identified using CPT procedure codes. Pertinent preoperative variables and rates of postoperative complications were characterized and analyzed.

Results

Our study found that elderly patients who received spinal anesthesia had, on average, longer length of stays but shorter operative times compared to patients who received general anesthesia. Furthermore, we found that patients who received spinal anesthesia had lower rates of systemic sepsis, cardiac arrests, and blood transfusions when compared to patients who received general anesthesia. Finally, we found that overall rates of mortality were significantly lower in the spinal anesthesia cohort compared to the general anesthesia cohort.

Conclusion

Our work suggests that patients who underwent spinal anesthesia for hip arthroplasty may have lower rates of postoperative complications. This work further highlights the role of anesthetic choice in preventing complications following hip hemiarthroplasty procedures.

Cummings SR et al (1995) Risk factors for hip fracture in white women. Study of osteoporotic fractures research group. N Engl J Med 332(12):767–773. https://doi.org/10.1056/NEJM199503233321202CrossRefPubMed

Nguyen T et al (1993) Prediction of osteoporotic fractures by postural instability and bone density. BMJ 307(6912):1111–1115. https://doi.org/10.1136/bmj.307.6912.1111CrossRefPubMedPubMedCentral

Gullberg B, Johnell O, Kanis JA (1997) World-wide projections for hip fracture. Osteoporos Int. 7(5):407–413. https://doi.org/10.1007/pl00004148CrossRefPubMed

Florschutz AV, Langford JR, Haidukewych GJ, Koval KJ (2015) Femoral neck fractures: current management. J Orthop Trauma 29(3):121–129. https://doi.org/10.1097/BOT.0000000000000291CrossRefPubMed

Rogmark C, Leonardsson O (2016) Hip arthroplasty for the treatment of displaced fractures of the femoral neck in elderly patients. Bone Jt. J. 98-B(3):291–297. https://doi.org/10.1302/0301-620X.98B3.36515CrossRef

Viswanath A, Malik A, Chan W, Klasan A, Walton NP (2020) Treatment of displaced intracapsular fractures of the femoral neck with total hip arthroplasty or hemiarthroplasty. Bone Jt J 102-B(6):693–698. https://doi.org/10.1302/0301-620X.102B6.BJJ-2019-1459.R1CrossRef

HEALTH investigators et al (2019) Total hip arthroplasty or hemiarthroplasty for hip fracture. N Engl J Med. 381(23):2199–2208. https://doi.org/10.1056/NEJMoa1906190CrossRef

Baker RP, Squires B, Gargan MF, Bannister GC (2006) Total hip arthroplasty and hemiarthroplasty in mobile, independent patients with a displaced intracapsular fracture of the femoral neck. A randomized, controlled trial. J Bone Joint Surg Am 88(12):2583–2589. https://doi.org/10.2106/JBJS.E.01373CrossRefPubMed

Memtsoudis SG et al (2013) Perioperative comparative effectiveness of anesthetic technique in orthopedic patients. Anesthesiology 118(5):1046–1058. https://doi.org/10.1097/ALN.0b013e318286061dCrossRefPubMed

10.

Gonano C, Leitgeb U, Sitzwohl C, Ihra G, Weinstabl C, Kettner SC (2006) Spinal versus general anesthesia for orthopedic surgery: anesthesia drug and supply costs. Anesth Analg 102(2):524–529. https://doi.org/10.1213/01.ane.0000194292.81614.c6CrossRefPubMed

11.

Owen AR et al (2022) Spinal compared with general anesthesia in contemporary primary total hip arthroplasties. J Bone Joint Surg Am 104(17):1542–1547. https://doi.org/10.2106/JBJS.22.00280CrossRefPubMed

12.

Turner EHG, Whalen CJ, Beilfuss MA, Hetzel SJ, Schroeder KM, Spiker AM (2021) Neuraxial anesthesia is associated with decreased pain scores and post-anesthesia care unit opioid requirement compared with general anesthesia in hip arthroscopy. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 37(1):139–146. https://doi.org/10.1016/j.arthro.2020.08.032CrossRef

13.

Pugely AJ, Martin CT, Gao Y, Mendoza-Lattes S, Callaghan JJ (2013) Differences in short-term complications between spinal and general anesthesia for primary total knee arthroplasty. JBJS 95(3):193–199. https://doi.org/10.2106/JBJS.K.01682CrossRef

14.

Kendall MC, Cohen AD, Principe-Marrero S, Sidhom P, Apruzzese P, De Oliveira G (2021) Spinal versus general anesthesia for patients undergoing outpatient total knee arthroplasty: a national propensity matched analysis of early postoperative outcomes. BMC Anesthesiol 21(1):226. https://doi.org/10.1186/s12871-021-01442-2CrossRefPubMedPubMedCentral

15.

Wilson JM, Farley KX, Erens GA, Guild GN (2019) General vs spinal anesthesia for revision total knee arthroplasty: do complication rates differ? J Arthroplasty 34(7):1417–1422. https://doi.org/10.1016/j.arth.2019.03.048CrossRefPubMed

16.

Neuman MD et al (2021) Spinal anesthesia or general anesthesia for hip surgery in older adults. N Engl J Med 385(22):2025–2035. https://doi.org/10.1056/NEJMoa2113514CrossRefPubMed

17.

Neuman MD, Silber JH, Elkassabany NM, Ludwig JM, Fleisher LA (2012) Comparative effectiveness of regional versus general anesthesia for hip fracture surgery in adults. Anesthesiology 117(1):72–92. https://doi.org/10.1097/ALN.0b013e3182545e7cCrossRefPubMed

18.

Desai V et al (2018) Is anesthesia technique associated with a higher risk of mortality or complications within 90 days of surgery for geriatric patients with hip fractures? Clin Orthop 476(6):1178–1188. https://doi.org/10.1007/s11999.0000000000000147CrossRefPubMedPubMedCentral

19.

Qiu C et al (2018) Impact of anesthesia on hospital mortality and morbidities in geriatric patients following emergency hip fracture surgery. J Orthop Trauma 32(3):116–123. https://doi.org/10.1097/BOT.0000000000001035CrossRefPubMed

20.

Ahn EJ, Kim HJ, Kim KW, Choi HR, Kang H, Bang SR (2019) Comparison of general anaesthesia and regional anaesthesia in terms of mortality and complications in elderly patients with hip fracture: a nationwide population-based study. BMJ Open 9(9):e029245. https://doi.org/10.1136/bmjopen-2019-029245CrossRefPubMedPubMedCentral

21.

Parker MJ, Handoll HHG, Griffiths R (2004) Anaesthesia for hip fracture surgery in adults. Cochrane Database Syst Rev. 4:CD000521. https://doi.org/10.1002/14651858.CD000521.pub2CrossRef

22.

Luger TJ et al (2010) Neuroaxial versus general anaesthesia in geriatric patients for hip fracture surgery: does it matter? Osteoporos Int 21(Suppl 4):S555-572. https://doi.org/10.1007/s00198-010-1399-7CrossRefPubMed

23.

Harris IA, Cuthbert A, de Steiger R, Lewis P, Graves SE (2019) Practice variation in total hip arthroplasty versus hemiarthroplasty for treatment of fractured neck of femur in Australia. Bone Jt J. 101-B(1):92–95. https://doi.org/10.1302/0301-620X.101B1.BJJ-2018-0666.R1CrossRef

24.

Burgers PTPW et al (2012) Total hip arthroplasty versus hemiarthroplasty for displaced femoral neck fractures in the healthy elderly: a meta-analysis and systematic review of randomized trials. Int Orthop 36(8):1549–1560. https://doi.org/10.1007/s00264-012-1569-7CrossRefPubMedPubMedCentral

25.

Wang X, Li H, Yuan C, Zhao H (2021) Association between type of anesthesia and length of hospital stay in primary unilateral total knee arthroplasty patients: a single-center retrospective study. J Orthop Surg 16(1):671. https://doi.org/10.1186/s13018-021-02817-4CrossRef

26.

Vora M, Samineni AV, Sing D, Salavati S, Tornetta P (2021) Spinal anesthesia associated with increased length of stay compared to general anesthesia for ankle open reduction internal fixation: a propensity-matched analysis. J Foot Ankle Surg. 60(2):350–353. https://doi.org/10.1053/j.jfas.2020.08.035CrossRefPubMed

27.

Mahan MC, Jildeh TR, Tenbrunsel T, Adelman BT, Davis JJ (2019) Time of return of neurologic function after spinal anesthesia for total knee arthroplasty: mepivacaine vs bupivacaine in a randomized controlled trial. Arthroplasty Today 5(2):226–233. https://doi.org/10.1016/j.artd.2019.03.003CrossRefPubMedPubMedCentral

28.

Pierce JT et al (2017) Efficiency of spinal anesthesia versus general anesthesia for lumbar spinal surgery: a retrospective analysis of 544 patients. Local Reg Anesth 10:91–98. https://doi.org/10.2147/LRA.S141233CrossRefPubMedPubMedCentral

29.

Phan K et al (2017) Anesthesia duration as an independent risk factor for early postoperative complications in adults undergoing elective ACDF. Glob Spine J 7(8):727–734. https://doi.org/10.1177/2192568217701105CrossRef

30.

Liu SS, McDonald SB (2001) Current issues in spinal anesthesia. Anesthesiology 94(5):888–906. https://doi.org/10.1097/00000542-200105000-00030CrossRefPubMed

31.

Capdevila X et al (2020) Factors determining the choice of spinal versus general anesthesia in patients undergoing ambulatory surgery: results of a multicenter observational study. Adv Ther 37(1):527–540. https://doi.org/10.1007/s12325-019-01171-6CrossRefPubMed

32.

Frost SA, Nguyen ND, Black DA, Eisman JA, Nguyen TV (2011) Risk factors for in-hospital post-hip fracture mortality. Bone 49(3):553–558. https://doi.org/10.1016/j.bone.2011.06.002CrossRefPubMed

33.

Macfarlane AJR, Prasad GA, Chan VWS, Brull R (2009) Does regional anaesthesia improve outcome after total hip arthroplasty? A systematic review. Br J Anaesth 103(3):335–345. https://doi.org/10.1093/bja/aep208CrossRefPubMed

34.

Ferreira AC, Hung CW, Ghanta RB, Harrington MA, Halawi MJ (2023) Spinal anesthesia is a grossly underutilized gold standard in primary total joint arthroplasty: propensity-matched analysis of a national surgical quality database. Arthroplasty Lond Engl 5(1):7. https://doi.org/10.1186/s42836-023-00163-wCrossRef

35.

Basques BA, Toy JO, Bohl DD, Golinvaux NS, Grauer JN (2015) General compared with spinal anesthesia for total hip arthroplasty. J Bone Joint Surg Am 97(6):455–461. https://doi.org/10.2106/JBJS.N.00662CrossRefPubMedPubMedCentral

36.

Tirumala V, Bounajem G, Klemt C, Maier SP, Padmanabha A, Kwon Y-M (2021) Outcome of spinal versus general anesthesia in revision total hip arthroplasty: a propensity score-matched cohort analysis. J Am Acad Orthop Surg 29(13):e656–e666. https://doi.org/10.5435/JAAOS-D-20-00797CrossRefPubMed

37.

McLain RF, Kalfas I, Bell GR, Tetzlaff JE, Yoon HJ, Rana M (2005) Comparison of spinal and general anesthesia in lumbar laminectomy surgery: a case-controlled analysis of 400 patients. J Neurosurg Spine 2(1):17–22. https://doi.org/10.3171/spi.2005.2.1.0017CrossRefPubMed

38.

Meng T, Zhong Z, Meng L (2017) Impact of spinal anaesthesia vs. general anaesthesia on peri-operative outcome in lumbar spine surgery: a systematic review and meta-analysis of randomised, controlled trials. Anaesthesia 72(3):391–401. https://doi.org/10.1111/anae.13702CrossRefPubMed

39.

Hofstad JK, Klaksvik J, Wik TS (2022) Intraoperatively local infiltration anesthesia in hemiarthroplasty patients reduces the needs of opioids: a randomized, double-blind, placebo-controlled trial with 96 patients in a fast-track hip fracture setting. Acta Orthop 93:111–116. https://doi.org/10.2340/17453674.2021.806CrossRefPubMedPubMedCentral

Titel: Postoperative complications of spinal vs general anesthesia in elderly patients undergoing hip hemiarthroplasty
verfasst von: Ashish R. Chowdary
Jack Beale
Jack Martinez
Vikram Aggarwal
Varatharaj Mounasamy
Senthil Sambandam
Publikationsdatum: 15.04.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: Archives of Orthopaedic and Trauma Surgery / Ausgabe 9/2023
Print ISSN: 0936-8051
Elektronische ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-023-04876-0

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen.
» Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Knie-TEP: Kein Vorteil durch antibiotikahaltigen Knochenzement

29.05.2024 Periprothetische Infektionen Nachrichten

Zur Zementierung einer Knie-TEP wird in Deutschland zu über 98% Knochenzement verwendet, der mit einem Antibiotikum beladen ist. Ob er wirklich besser ist als Zement ohne Antibiotikum, kann laut Registerdaten bezweifelt werden.

Häusliche Gewalt in der orthopädischen Notaufnahme oft nicht erkannt

28.05.2024 Häusliche Gewalt Nachrichten

In der Notaufnahme wird die Chance, Opfer von häuslicher Gewalt zu identifizieren, von Orthopäden und Orthopädinnen offenbar zu wenig genutzt. Darauf deuten die Ergebnisse einer Fragebogenstudie an der Sahlgrenska-Universität in Schweden hin.

Fehlerkultur in der Medizin – Offenheit zählt!

28.05.2024 Fehlerkultur Podcast

Darüber reden und aus Fehlern lernen, sollte das Motto in der Medizin lauten. Und zwar nicht nur im Sinne der Patientensicherheit. Eine negative Fehlerkultur kann auch die Behandelnden ernsthaft krank machen, warnt Prof. Dr. Reinhard Strametz. Ein Plädoyer und ein Leitfaden für den offenen Umgang mit kritischen Ereignissen in Medizin und Pflege.

Mehr Frauen im OP – weniger postoperative Komplikationen

21.05.2024 Allgemeine Chirurgie Nachrichten

Ein Frauenanteil von mindestens einem Drittel im ärztlichen Op.-Team war in einer großen retrospektiven Studie aus Kanada mit einer signifikanten Reduktion der postoperativen Morbidität assoziiert.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Postoperative complications of spinal vs general anesthesia in elderly patients undergoing hip hemiarthroplasty