Is Anesthesia Technique Associated With a Higher Risk of Mortality or Complications Within 90 Days of Surgery for Geriatric Patients With Hip Fractures?

Background: Postoperative mortality and complications after geriatric hip fracture surgery remain high despite efforts to improve perioperative care for these patients. One factor of particular interest is anesthetic technique, but prior studies on this are limited by sample selection, competing risks, and incomplete followup.

Questions/purposes: (1) Among older patients undergoing surgery for hip fracture, does 90-day mortality differ depending on the type of anesthesia received? (2) Do 90-day emergency department returns and hospital readmissions differ based on anesthetic technique after geriatric hip fracture repairs? (3) Do 90-day Agency for Healthcare Research and Quality (AHRQ) outcomes differ according to anesthetic techniques used during hip fracture surgery?

Methods: We conducted a retrospective study on geriatric patients (65 years or older) with hip fractures between 2009 and 2014 using the Kaiser Permanente Hip Fracture Registry.

Impact of Anesthesia on Hospital Mortality and Morbidities in Geriatric Patients Following Emergency Hip Fracture Surgery.

Objectives: To determine the impact of anesthesia type on in-hospital mortality and morbidity for geriatric fragility hip fracture surgery.

Design: Retrospective cohort study.

Setting: Integrates health care delivery system across 38 facilities in the United States.

A Community-Based Hip Fracture Registry: Population, Methods, and Outcomes.

Cases of hip fracture recorded from 1/2009 to 12/2011 were ascertained using the Kaiser Permanente Hip Fracture Registry. The registry collects information on patient, procedure, surgeon, facility, and surgical outcomes. The population (N = 12,562) was predominantly white, women, and older (≥ 75 years), and 32% had at least 5 comorbidities.

The impact of the garden classification on proposed operative treatment.

The current study evaluates the interobserver reliability and intraobserver reproducibility of the Garden classification of femoral neck fractures, assesses the influence of a lateral radiograph on a fracture's classification, and determines the classification's impact on the surgeon's choice of operative treatment. Forty radiographs of femoral neck fractures were evaluated independently by five orthopaedic surgeons. Kappa values were calculated for interobserver reliability and intraobserver variability with respect to the readers' ability to assess the fractures using the Garden classification and to determine fracture displacement with and without access to a lateral radiograph.