Effect of different anesthetic methods on postoperative outcomes in elderly patients undergoing hip fracture surgery / 北京大学学报(医学版)

ABSTRACT

Objective:To investigate the effect of general or regional anesthesia on postoperative cardiopulmonary complications and inpatient mortality after hip fracture surgery in elderly patients.Methods:A retrospective analysis was conducted according to the medical records of 572 elderly patients with hip fractures admitted to our hospital from January 1,2005 to December 31,2014.The age,gender,preoperative comorbidities,length of preoperative bedridden time,mechanism of injury,surgical types,anesthetic methods,major postoperative complications and inpatient mortality were recorded.Multivariate Logistic regression analysis was applied to analyze the impact of different anesthetic methods on inpatient mortality in these patients.Results:Of the 572 patients,392 (68.5％) received regional anesthesia.Inpatient death occurred in 8 (8/572,mortality1.4％),including 5 cases of RA group (5/392,mortality1.3％) and 3 cases of GA group (3/180,mortality1.7％).There was no statistically significant difference between the two groups in inpatient mortality (P ＞ 0.05).Multiple Logistic regression analysis showed that gender (odds ratio0.18,95％ CI0.03-1.05,P =0.057),age (odds ratio1.22,95％ CI1.07-1.38,P =0.002),preoperative pulmonary comorbidities (odds ratio12.09,95％ CI2.28-64.12,P =0.003) and surgical types (odds ratio9.36,95％ CI1.34-64.26,P =0.024) were risk factors for inpatient mortality.Postoperative cardiovascular complications occurred in 36 patients (36/572,morbidity6.3％),with 19 patients in RA group (19/392,morbidity4.8％),and 17 patients in GA group (17/180,morbidity9.4％).Multiple Logistic regression analysis showed that age (odds ratio1.13,95％ CI1.07-1.19,P ＜ 0.001),hypertension (odds ratio2.72,95％ CI1.24-5.96,P =0.012) and preoperative cerebral comorbidities (odds ratio2.11,95％ CI0.99-4.52,P =0.054) were risk factors for postoperative cardiovascular complications.Postoperative pulmonary complications occurred in 56 patients (56/572,morbidity9.8％),with 19 patients in RA group (19/392,morbidity4.8％),and 37 patients in GA group (37/180,morbidity20.6％).Multiple Logistic regression analysis showed that age (odds ratio1.13,95％ CI1.07-1.19,P ＜0.001),preoperative pulmonary comorbidities (odds ratio2.89,95％ CI1.28-7.05,P=0.020),length of preoperative bedridden time (odds ratio1.11,95％ CI1.04-1.18,P =0.003) and anesthetic methods (odds ratio5.86,95％ CI2.98-11.53,P ＜ 0.001) were risk factors for postoperative pulmonary complications.Conclusion:General anesthesia may not affect the inpatient mortality after hip fracture surgery in elderly patients.Regional anesthesia is associated with a lower risk of pulmonary complications after surgical procedure compared with general anesthesia.