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Patients who undergo hip fracture repair surgery have the same risk of postoperative problems or death whether they receive regional (epidural or spinal) or general anesthesia during surgery, finds a study supported in part by the Agency for Healthcare Research and Quality (HS07322). Thus, the type of anesthesia used should depend on other factors such as patient characteristics (for example, other illnesses and age), according to the researchers. They retrospectively reviewed the medical charts of patients 60 years of age or older who underwent hip fracture repair at 20 study hospitals in 4 metropolitan areas between 1983 and 1993.
The researchers found greater use of regional anesthesia for hip fracture repair in recent years. In 1981 and 1982, general anesthesia was used for 95 percent of patients but in only 50 percent of patients by 1993-1994. However, there was considerable variability in use of regional anesthesia among institutions, ranging from 13 to 97 percent. Of the 9,425 patients (most patients were women with a mean age of 80 years) studied, general anesthesia was used for 66 percent and regional anesthesia for the remaining 34 percent. The unadjusted 30-day mortality rate was 4.4 percent in the general anesthesia group and 5.4 percent in the regional anesthesia group, which was older and more sick (more apt to have a history of cardiovascular or chronic obstructive lung disease).
After adjusting for patient differences, there were no significant differences in 7-day mortality rates among patients who had regional versus general anesthesia. There also were no significant differences between the two groups in rate of postoperative problems, such as postoperative pneumonia or congestive heart failure. Thus, type of anesthesia was not associated with morbidity or mortality.
The study's principal investigator was Jeffrey L. Carson, M.D., of the University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School. His colleagues are from the University of Pennsylvania School of Medicine, Brown University School of Medicine, the University of Texas at San Antonio, and the Medical College of Virginia.
See "The effect of anesthetic technique on postoperative outcomes in hip fracture repair," by Dorene A. O'Hara, M.D., M.S.E., Amy Huff, M.H.S., Jesse A. Berlin, Sc.D., and others, in Anesthesiology 92, pp. 947-957, 2000.
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