Choosing the Appropriate Anaesthesia for Elderly Hip Fractures: Regional versus General in a Large Single-centre Cohort

Background:
Hip fractures are frequent among the elderly, causing significant morbidity and mortality. Perioperative complications are often associated with those complications, and the preferred type of anaesthesia used is still an ongoing debate. This study aimed to compare general anaesthesia with regional postoperative complications and mortality for patients with hip fractures.

Methods:
Retrospective cohort of 368 patients underwent hip fracture surgery in our centre in a single year. Excluded patients were patients who before surgery had lung pathology, anaesthesia method shift while in the operative room, refused a blood transfusion, metastatic bone malignancy, Multiple-myeloma, multi-trauma, multi-surgeries (hip plus other surgery), paraplegic or quadriplegic. Records of all patients were summed, including past medical history, demographics, anaesthesia method, time of surgery, ASA and complications while in admission. Logistic regression used to study the association between type of anaesthesia and complications.

Results:
We summed 368 patients of a period of one year operated for hip fracture. Two excluded. Patients were part of two wings – general (278 patients) versus spinal (88 patients) anaesthesia. The average age was 79.6±12.6, and 30.9% were males. Complications categories included lung (8.6%), major complications (3.3%), general complications (6.8%) and in admission death (2.2%). Type of anaesthesia was significantly associated with complications as well as age and ASA score. General anaesthesia was associated with 5.4 times the risk of complications versus spinal. Major complications were only associated with age, while lung complications were associated with a history of lung diseases.

Conclusion:
General anaesthesia is associated with a higher complication rate in hip fracture surgery for the elderly but not for significant complications, lung complications and death.