Document Type : Original Article

Authors

1 Department of Anesthesiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

2 Department of Nursing, School of Nursing, Gerash University of Medical Sciences, Gerash, Iran

3 Gerash Amir-al-Momenin Medical and Educational Center, Gerash University of Medical Sciences, Gerash, Iran

4 Department of Anesthesiology, School of Nursing, Gerash University of Medical Sciences, Gerash, Iran

5 Department of Biostatistics, School of Paramedical, Gerash University of Medical Sciences, Gerash, Iran

6 Department of Nursing, School of Nursing, Larestan University of Medical Sciences, Larestan, Iran

7 Medical Student, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

Abstract

Background: There are still conflicting results on the
postoperative consequences of patients with hip and femoral
fractures based on the type of anesthesia. The aim of this study
was to compare mortality and morbidity of general and spinal
anesthesia in patients undergoing hip and femoral fractures.
Methods: In this analytical cross-sectional study, the information
of 93 patients who had undergone hip and femoral surgery with
general and spinal anesthesia was studied during 2011-2019 in
the medical records by census method. Data were analyzed using
SPSS 23 software and descriptive and analytical statistics.
Results: The general anesthesia group consisted of 29 patients
and the spinal anesthesia group included 64 patients. The two
groups were the same in terms of demographic information,
preoperative hemodynamic variables, and previous medical
history. The results of the independent t-test with a significance
level of 5% did not show a significant difference between the
two groups in the following variables: mean duration of surgery
and duration of anesthesia, mean arterial pressure and heart
rate after surgery, changes in blood pressure, and heart rate
during surgery, bleeding, intravenous fluids and blood products
intake, postoperative hemoglobin, number of days hospitalized
in the Intensive Care Unit and surgical ward. The mean postoperative mean arterial pressure score in the general anesthesia
group was significantly higher than the spinal group (P=0.004).
Complications and mortality after surgery did not differ between
the two types of anesthesia.
Conclusion: In general, these two methods of anesthesia do not
differ from each other in terms of postoperative complications and
mortality, and physicians can choose the appropriate anesthesia
method according to the specific conditions of the patients

Keywords

1. Lehtonen EJI, Stibolt Jr RD, Smith W, Wills B, Pinto MC, McGwin Jr G, et al. Trends in surgical treatment of femoral neck fractures in the elderly. Einstein (São Paulo). 2018;16(3):eAO4351.
2. Curtis EM, van der Velde R, Moon RJ, van den Bergh JP, Geusens P, de Vries F, et al. Epidemiology of fractures in the United Kingdom 1988-2012: Variation with age, sex, geography, ethnicity and socioeconomic status. Bone. 2016;87:19–26.
3. Keshtkar A, Larijani B, Satleghi M, Majidian M, Heshmat R. The incidence of osteoporotic hip fracture in Iran, a review. Osteoporos Int. 2010;21:S707–S07.
4. Maharlouei N, Atefi S, Namazi H, Kazemifar S, Soveid M, Shahraki HR et al. The incidence of hip fracture in Shiraz, Iran: a promising rate comparing to previous studies. Osteoporos Int. 2017;28:1989–1993.
5. Hinkle, JL. Cheever K. Brunner and Suddarths Textbook Of Medical-surgical Nursing. 14th ed. Philadelphia: Wolters Kluwer; 2018. 6112 p.
6. Foroozeshfard M, Mirzayikhah M, Sheikhi A, Kia N, Mirmohammadkhani M, Poorazizi M. Hip Fracture in Ederly Patients and Their Post-Surgery Fate. Iran J Orthop Surg. 2014;12(4):154–9.
7. Yeganeh A, Khatami F, Abolghasemian M. Mortality Rate in the First Year after Hip Fracture in 65 Year Old or Older Patients in Rasool Akram Hospital (Tehran). J Babol Univ Med Sci. 2014;16(1):112–6.
8. Neuman MD  Ludwig JM, et al. RPR.  Anesthesia technique, mortality, and length of stay after hip fracture surgery. JAMA. 2014;311:2508–17.
9. Klestil T, Röder C, Stotter C, Winkler B NS, Lutz M et al. Impact of timing of surgery in elderly hip fracture patients: a systematic review and meta-analysis. Sci Rep. 2018;8(1):13933.
10. Mohd-Tahir N-A, Li S-C. Economic burden of osteoporosis-related hip fracture in Asia: a systematic review. Osteoporos Int. 2017;28:2035–2044.
11. sadati L, Golchini E. Orthopedic surgical technology. 2th ed. Tehran: jame negar; 2019. 200 p.
12. White SM, Griffiths R, Holloway J, Shannon A. Anaesthesia for proximal femoral fracture in the UK: first report from the NHS Hip Fracture Anaesthesia Network. Anaesthesia. 2010;65(3):243–8.
13. Nagelhout JJ, Plaus KL. Regional Anesthesia. In: Nurse anesthesia. 5th ed. St.louis: Elsevier Saunders; 2013. p. 1424.
14. Miler RD, Pardo M. choice of anesthetic technique. In: Abtahi.D, editor. Basics of Anesthesia. 6th ed. Tehran: andishe raf; 2014. p. 224–7.
15. Helwani MA, Avidan MS, Ben Abdallah A, Kaiser DJ, Clohisy JC, Hall BL, et al. Effects of regional versus general anesthesia on outcomes after total hip arthroplasty: a retrospective propensity-matched cohort study. J Bone Jt Surg Am. 2015;97(3):186–93.
16. Bai B, Ruan X, Zhang YL, Chen K, Jin XX, Tian Y, et al. [Effect of anesthesia on cardiopulmonary complications in elderly patients with hip fracture]. Zhonghua Yi Xue Za Zhi. 2018;98(40):3240–3.
17. Rashid RH, Shah AA, Shakoor A, Noordin S. Hip Fracture Surgery: Does Type of Anesthesia Matter? Biomed Res Int. 2013;2013(2):1–5.
18. Qiu C, Chan PH, Zohman GL, Prentice HA, Hunt JJ, LaPlace DC, et al. Impact of Anesthesia on Hospital Mortality and Morbidities in Geriatric Patients Following Emergency Hip Fracture Surgery. J Orthop Trauma. 2018;32(3):116–23.
19. Van Waesberghe J, Stevanovic A, Rossaint R, Coburn M. General vs. neuraxial anaesthesia in hip fracture patients: a systematic review and meta-analysis. BMC Anesth. 2017;17(1):87.
20. Chen DX, Yang L, Ding L, Li SY, Qi YN, Li Q. Perioperative outcomes in geriatric patients undergoing hip fracture surgery with different anesthesia techniques: A systematic review and meta-analysis. Med. 2019;98(49):e18220.
21. Guay J, Parker MJ, Gajendragadkar PR, Kopp S. Anaesthesia for hip fracture surgery in adults. Cochrane Database Syst Rev [Internet]. 2016;(2). Available from: https://doi.org//10.1002/14651858.CD000521.pub3
22. Neuman MD, Silber JH, Elkassabany NM, Ludwig JM, Fleisher LA. Comparative effectiveness of regional versus general anesthesia for hip fracture surgery in adults. Anesthesiology. 2012;117(1):72–92.
23. Regan EA, Radcliff TA, Henderson WG, Cowper Ripley DC, Maciejewski ML, Vogel WB, et al. Improving hip fractures outcomes for COPD patients. COPD. 2013;10(1):11–9.
24. White SM, Moppett IK, Griffiths R. Outcome by mode of anaesthesia for hip fracture surgery. An observational audit of 65 535 patients in a national dataset. Anaesthesia. 2014;69(3):224–30.
25. White S, Griffiths R, Moppett I. Type of anaesthesia for hip fracture surgery - The problems of trial design. Anaesthesia. 2012;67:574–8.
26. Urwin SC, Parker MJ, Griffiths R. General versus regional anaesthesia for hip fracture surgery: a meta-analysis of randomized trials. Br J Anaesth. 2000;84(4):450–5.
27. Basques BA, Bohl DD, Golinvaux NS, Samuel AM, Grauer JG. General versus spinal anaesthesia for patients aged 70 years and older with a fracture of the hip. Bone Jt J. 2015;97-b(5):689–95.
28. Wood RJ, White SM. Anaesthesia for 1131 patients undergoing proximal femoral fracture repair: a retrospective, observational study of effects on blood pressure, fluid administration and perioperative anaemia. Anaesthesia. 2011;66(11):1017–22.
29. Seitz DP, Gill SS, Bell CM, Austin PC, Gruneir A, Anderson GM, et al. Postoperative medical complications associated with anesthesia in older adults with dementia. J Am Geriatr Soc. 2014;62(11):2102–9.
30. Desai V, Chan PH, Prentice HA, Zohman GL, Diekmann GR, Maletis GB, et al. 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 Relat Res. 2018;476(6):1178–88.
31. Palabıyık O, Bayar F, Caglar T, Toptas Y, Erdem AF, Tuna AT. Anesthetic Techniques in Octogenarians and Older Undergoing Orthopedic Surgery for Hip Fracture. J Clin Exp Investig. 2017;8(3):85–9.