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Comparative Study
. 2014 Jun 27:348:g4022.
doi: 10.1136/bmj.g4022.

Comparative safety of anesthetic type for hip fracture surgery in adults: retrospective cohort study

Elisabetta Patorno  1 , Mark D Neuman  2 , Sebastian Schneeweiss  3 , Helen Mogun  3 , Brian T Bateman  4
Affiliations
Comparative Study

Comparative safety of anesthetic type for hip fracture surgery in adults: retrospective cohort study

Elisabetta Patorno et al. BMJ. .

Abstract

Objective: To evaluate the effect of anesthesia type on the risk of in-hospital mortality among adults undergoing hip fracture surgery in the United States.

Design: Retrospective cohort study.

Setting: Premier research database, United States.

Participants: 73,284 adults undergoing hip fracture surgery on hospital day 2 or greater between 2007 and 2011. Of those, 61,554 (84.0%) received general anesthesia, 6939 (9.5%) regional anesthesia, and 4791 (6.5%) combined general and regional anesthesia.

Main outcome measure: In-hospital all cause mortality.

Results: In-hospital deaths occurred in 1362 (2.2%) patients receiving general anesthesia, 144 (2.1%) receiving regional anesthesia, and 115 (2.4%) receiving combined anesthesia. In the multivariable adjusted analysis, when compared with general anesthesia the mortality risk did not differ significantly between regional anesthesia (risk ratio 0.93, 95% confidence interval 0.78 to 1.11) or combined anesthesia (1.00, 0.82 to 1.22). A mixed effects analysis accounting for differences between hospitals produced similar results: compared with general anesthesia the risk from regional anesthesia was 0.91 (0.75 to 1.10) and from combined anesthesia was 0.98 (0.79 to 1.21). Findings were also consistent in subgroup analyses.

Conclusions: In this large nationwide sample of hospital admissions, mortality risk did not differ significantly by anesthesia type among patients undergoing hip fracture surgery. Our results suggest that if the previously posited beneficial effect of regional anesthesia on short term mortality exists, it is likely to be more modest than previously reported.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: SS is principal investigator of the Harvard-Brigham Drug Safety and Risk Management Research Center funded by the Food and Drug Administration. His work is partially funded by grants/contracts from the Patient-Centered Outcomes Research Institute, the FDA, and the National Heart, Lung, and Blood Institute; SS is consultant to WHISCON and LLC, and to Aetion, a software manufacturer of which he also owns shares, and he is principal investigator of investigator initiated grants to the Brigham and Women’s Hospital from Novartis and Boehringer-Ingelheim unrelated to the topic of this study.

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Flowchart of study cohort
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