Use of regional anesthesia during hip fracture surgery not associated with lower risk of death
Among more than 56,000 adults undergoing hip repair between 2004 and 2011, the use of regional anesthesia compared with general anesthesia was not associated with a lower risk of death at 30 days, but was associated with a modestly shorter length of hospital stay, according to a study in JAMA.
Each year, more than 300,000 hip fractures occur in the United States, which can lead to functional disability and death. Regional anesthesia for hip fracture surgery may reduce postoperative complications, and practice guidelines have called for broader use of regional anesthesia for hip fracture surgery, according to background information in the article.
Mark D. Neuman, M.D., M.Sc., of the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, and colleagues assessed the association of regional (i.e., spinal or epidural) anesthesia vs general anesthesia with 30-day mortality and hospital length of stay after hip fracture surgery. The study included patients 50 years or older who were undergoing surgery for hip fracture at general acute care hospitals in New York State between July 2004 and December 2011.
Of 56,729 patients, 15,904 (28 percent) received regional anesthesia and 40,825 (72 percent) received general anesthesia. Overall, 3,032 patients (5.3 percent) died within 30 days of surgery. The researchers did not observe a statistically significant difference in mortality according to anesthesia technique. They did find that regional anesthesia was associated with approximately a half day shorter length of hospital stay.
"Our findings may have implications for clinical practice and health policy. Regional anesthesia is used as the primary anesthetic technique in a minority of hip fracture surgeries performed in the United States and in other countries, and increasing its use has been proposed as a strategy to improve the quality of hip fracture care. We found an association between greater use of regional anesthesia and a reduction in length of stay after hip fracture; however, we did not find regional anesthesia to be associated with statistically significant differences in mortality" the authors write.
"These findings do not support a mortality benefit for regional anesthesia in this setting.