Anesthetic Techniques in Octogenarians and Older Undergoing Orthopedic Surgery for Hip Fracture

Yıl 2017, Cilt: 8 Sayı: 3, 85 - 89, 30.09.2017

Onur Palabıyık , Fikret Bayar Tugba Caglar

https://doi.org/10.5799/jcei.343194

Öz

Objectives: Hip fracture is common orthopedic problems for patients aged 80 years and older.
Because of their decreased cardiopulmonary capacity, an optimal anesthetic technique should
be chosen by anesthesiologists. The purpose of the present study is to analyze anesthetic
techniques and related postoperative mortality in octogenarians and older who underwent hip
fractures surgery.
Patients and Methods: We analyzed hip fracture surgeries and identified patients aged 80
years and older between January 2012 and December 2013. Patient age, gender, coexisting
diseases, American Society of Anesthesiologists (ASA) Physical Status classification, anesthetic
technique, hematocrit, hemoglobin, total lymphocyte count (TLC), the length of surgery,
intraoperative blood transfusion requirements, postoperative discharge ward, the length of
postoperative hospital stay, and postoperative status were recorded.
Results: We retrospectively identified 106 patients aged 80 years and older underwent hip
fracture surgeries. Six (5.6%), 36 (34.0%), 2 (1.9%), 53 (50.0%), and 9 (8.5%) of procedures were
performed under general anesthesia (GA), spinal anesthesia (SA), epidural anesthesia, combined
spinal-epidural anesthesia (CSEA), and peripheral nerve block (PNB), respectively. The
postoperative 7 and 30-day mortality were 6.6% and 10.4%, respectively. Age, gender, ASA,
hematocrit, hemoglobin, TLC, discharge to the ward, the length of postoperative hospital stay,
and the postoperative mortality rates were similar between the GA, SA, CSEA, and PNB. There
was no relationship between postoperative mortality and anesthetic technique.
Conclusion: In octogenarians and older, the postoperative mortality is higher after hip fracture
and is not associated with the anesthetic technique. 

Anahtar Kelimeler

Octogenarians, general anesthesia, central neuraxial block, peripheral nerve block, mortality

Kaynakça

• 1. Parker MJ, Handoll HHG, Griffiths R. Anaesthesia for hip fracture surgery in adults. Cochrane Database of Syst Rev 2004;4:CD000521.
• 2. Chung JY, Chang WY, Lin TW, Lu JR, Yang MW, Lin CC, et al. An analysis of surgical outcomes in patients aged 80 years and older. Acta Anaesthesiol Taiwan 2014;52:153-8.
• 3. Zeltzer J, Mitchell RJ, Toson B, Harris IA, Ahmad L, Close J. Orthogeriatric services associated with lower 30-day mortality for older patients who undergo surgery for hip fracture. MJA 2014;201:409-11.
• 4. Beaupre LA, Jones CA, Saunders LD, Johnston DW, Buckingham J, Majumdar SR. Best practices for elderly hip fracture patients. A systematic overview of the evidence. J Gen Intern Med 2005;20:1019-25.
• 5. Nyholm AM, Gromov K, Palm H, Brix M, Kallemose T, Troelsen A. Time to surgery is associated with thirty-day and ninety-day mortality after proximal femoral fracture: a retrospective observational study on prospectively collected data from the Danish Fracture Database Collaborators. J Bone Joint Surg Am 2015;97:1333-9.
• 6. Karaman Ö, Özkazanlı G, Orak MM, Mutlu S, Mutlu H, Çalışkan G, et al. Factors affecting postoperative mortality in patients older than 65 years undergoing surgery for hip fracture. Ulus Travma Acil Cerrahi Derg 2015;21:44-50.
• 7. Haentjens P, Magaziner J, Colon-Emeric CS, Vanderschueren D, Millisen K, Velkeniers B, et al. Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med 2010;152:380-90.
• 8. Richmond J, Aharonoff GB, Zuckerman JD, Koval KJ. Mortality risk after hip fracture. J Orthop Trauma 2003;17(8 Suppl):S2-5.
• 9. Vestergaard P, Rejnmark L, Mosekilde L. Has mortality after a hip fracture increased? J Am Geriatr Soc 2007;55:1720-6.
• 10. Peled E, Barak M, Keren Y, Soudry M, Norman D. Predictors for adverse outcome in patients aged 80 years and older undergoing emergent hip fractures. Surgical Science 2011;2:463-7.
• 11. Saricaoglu F, Akinci SB, Atay S, Caglar O, Aypar U. [The effects of anesthesia techniques on postoperative mortality in elderly geriatric patients operated for femoral fractures]. Turkish Journal of Geriatrics 2012;15(4):434-8.
• 12. 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;66:1017-22.
• 13. Jamsen E, Puolakka T, Eskelinen A, Jantti P, Kalliovalkama J, Nieminen J, et al. Predictors of mortality following primary hip and knee replacement in the aged. A single-center analysis of 1,988 primary hip and knee replacement for primary osteoarthritis. Acta Orthop 2013;84:44-53.
• 14. Le-Wendling L, Bihorac A, Baslanti TO, Lucas S, Sadasivan K, Wendling A, et al. Regional anesthesia as compared to general anesthesia for surgery in geriatric patients with hip fracture: Does it decrease morbidity, mortality and healthcare costs? Results of a single-centered study. Pain Med 2012;13:948-56.
• 15. de Luise C, Brimacombe M, Pedersen L, Sorensen HT. Comorbidity and mortality following hip fracture: a population-based cohort study. Aging Clin Exp Res 2008; 20:412-8.
• 16. Kreder HJ, Berry GK, McMurtry IA, Halman SI. Arthroplasty in the octogenarian: quantifying the risks. J Arthroplasty 2005;20:289-293.
• 17. Liu LL, Leung JM. Predicting adverse postoperative outcomes in patients aged 80 years or older. J Am Geriatr Soc 2000; 48:405-12.
• 18. Kuo FC, Hsu CH, Chen WS, Wang JW. Total knee arthroplasty in carefully selected patients aged 80 years or older. J Orthop Surg Res 2014;9:61.
• 19. Macfarlane AJR, Prasad GA, Chan VWS, Brull R. Does regional anesthesia improve outcome after total knee arthroplasty? Clin Orthop Relat Res 2009;467:2379-402.
• 20. Karaman S, Karaman T, Dogru S, Sahin A, Arici S. [The effects of anesthesia techniques on morbidity-mortality in geriatric patients underwent orthopedic surgery]. J Contemp Med 2014;4:143-50.
• 21. Hekimoglu Sahin S, Heybeli N, Colak A, Arar C, Alan K, Copuroglu C, et al. Comparison of different anesthetic techniques on postoperative outcomes in elderly patients with hip fracture. Turkiye Klinikleri J Med Sci 2012;32:623-9.
• 22. Le Manach Y, Collins G, Bhandari M, Bessissow A, Boddaert J, Khiami F, et al. Outcomes after hip fracture surgery compared with elective total hip replacement. JAMA. 2015;314:1159-66.
• 23. Yli-Kyyny T, Sund R, Heinanen M, Venesmaa P, Kröger H. Cemented or uncemented hemiarthroplasty for the treatment of femoral neck fractures? A Finnish database study of 25,174 patients. Acta Orthop 2014; 85:49-53.
• 24. Rodgers A, Walker N, Schug S, McKee A, Kehlet H, vanZundert A. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ 2000; 321:1493-7.
• 25. Koval KJ, Aharonoff GB, Rosenberg AD, Schmigelski C, Bernstein RL, Zuckerman JD. Hip fracture in the elderly: the effect of anesthetic technique. Orthopedics 1999; 22:31-34.