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Regional anaesthesia for hip fracture surgery is associated with significantly more peri-operative complications compared with general anaesthesia

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Abstract

Introduction

Although several studies have advocated the use of regional versus general anaesthesia as a means of reducing peri-operative complications from hip fracture surgery, the ideal method of anaesthesia remains controversial. Our purpose was to investigate the association between anaesthesia type and peri-operative complications in hip fracture surgery.

Methods

From the 2005–2011 ACS-NSQIP database, all patients with operatively treated hip fractures were identified using CPT codes, and fifteen peri-operative complications were recorded and categorized as either minor or major. Rates of minor, major, and total complications by anaesthesia type were compared using chi-square and Fischer’s exact tests. A multivariate model was used to determine odds of minor, major, and total complications between anaesthesia types. Multivariate analysis was then repeated after combining patients who received regional nerve blocks or spinal anaesthesia.

Results

A total of 7,764 hip fracture patients were included in our analysis. Spinal anaesthesia had the highest total complication rate (19.6 %), followed by general (17.9 %) and regional nerve blocks (12.6 %). Multivariate analysis demonstrated that spinal anaesthesia was associated with significantly greater odds of minor complications and total complications compared with general anaesthesia. After combining the regional nerve block and spinal anaesthesia groups, multivariate analysis again showed significantly greater odds of minor and total complications with regional versus general anaesthesia.

Conclusions

Using a large multi-centre database, we demonstrate that regional anaesthesia was associated with significantly greater odds of minor and total peri-operative complications compared with general anaesthesia. Our results challenge the notion that regional anaesthesia is the preferred method of anaesthesia for hip fractures in the elderly.

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Conflict of interest

Author William Obremskey has previously consulted for biometrics, done expert testimony in legal matters, has a grant from the Department of Defense, and has been a Board Member of the OTA and SEFC. For the remaining authors no conflicts of interest were declared.

Copyrighted material/consent forms

This study used no previously-copyrighted materials or signed patient consent forms.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

IRB approval

This study has approval from the Vanderbilt IRB.

Ethical review committee statement

This study was performed in accordance with the relevant regulations of the US Health Insurance Portability and Accountability Act (HIPAA) and the ethical standards of the 1964 Declaration of Helsinki.

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Authors and Affiliations

  1. The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue South, Suite 4200, Medical Center East, South Tower, Nashville, TN, 37232, USA

    Paul S. Whiting, Cesar S. Molina, Sarah E. Greenberg, Rachel V. Thakore, William T. Obremskey & Manish K. Sethi

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  1. Paul S. Whiting
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  2. Cesar S. Molina
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  3. Sarah E. Greenberg
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  4. Rachel V. Thakore
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  5. William T. Obremskey
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  6. Manish K. Sethi
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Corresponding author

Correspondence to Manish K. Sethi.

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Whiting, P.S., Molina, C.S., Greenberg, S.E. et al. Regional anaesthesia for hip fracture surgery is associated with significantly more peri-operative complications compared with general anaesthesia. International Orthopaedics (SICOT) 39, 1321–1327 (2015). https://doi.org/10.1007/s00264-015-2735-5

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  • DOI: https://doi.org/10.1007/s00264-015-2735-5

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