Comparison of the 30-Day Mortality Rate of Hip Fracture Surgery in Patients Over 50 Years Old with the Underlying Disease who Underwent General and Neuraxial Anesthesia in a General Hospital for 4 Years

Derakhshan, Pooya; Nikoubakht, Nasim; Kazeranian, Golnaz; Mousavi, Mahdi

doi:10.30491/tm.2024.471943.1758

Comparison of the 30-Day Mortality Rate of Hip Fracture Surgery in Patients Over 50 Years Old with the Underlying Disease who Underwent General and Neuraxial Anesthesia in a General Hospital for 4 Years

Document Type : Original Article

Authors

Pooya Derakhshan ¹

Nasim Nikoubakht ²

Golnaz Kazeranian ³

Mahdi Mousavi ³

¹ Pain Research Center, Department of Anesthesiology and Pain Medicine, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran.

² Associate Professor of Anesthesiology Department of Anesthesiology, School of Medicine Hazrat-e Rasool General Hospital Iran University of Medical Sciences.

³ School of Medicine, Iran University of Medical Sciences, Tehran, Iran.

10.30491/tm.2024.471943.1758

Abstract

Introduction: Hip fractures are a critical issue among the elderly, often resulting from osteoporosis, and pose a significant global health challenge. With an estimated 10 million cases annually, the complexity of anesthesia choice is heightened by the elderly's prevalent comorbidities.
Methods: This retrospective cohort study, conducted at Rasool Akram Hospital from April 2017 to April 2021, investigates the 30-day postoperative mortality rates in over 50 patients undergoing hip fracture surgery. It compares outcomes between general and neuraxial anesthesia and examines the influence of comorbidities and fracture types on mortality.
Results: The study encompassed 437 patients, with a notable difference in mortality rates: 5.6% for general anesthesia versus 13.8% for neuraxial anesthesia (P = 0.006). A propensity for neuraxial anesthesia was observed in patients over 75 and those with cardiac conditions (P = 0.004 and P = 0.006, respectively). Smokers and patients with intertrochanteric fractures also exhibited higher mortality under neuraxial anesthesia. The mortality rates did not significantly vary among neuraxial anesthesia subtypes.
Conclusions: The anesthesia method significantly impacts the 30-day mortality rate in elderly hip fracture patients with comorbidities. General anesthesia is associated with lower mortality than neuraxial anesthesia. These findings highlight the importance of meticulous preoperative evaluation and tailored anesthesia strategies to enhance patient outcomes. The study advocates for personalized care to navigate the complexities of anesthesia selection and improve surgical success rates in this vulnerable population.

Keywords

Hip Fractures

Neuraxial anesthesia

General anesthesia

Mortality

Intertrochanteric fracture

Subjects