Date Published: January 12, 2012
Publisher: Hindawi Publishing Corporation
Author(s): Saffet Karaca, Egemen Ayhan, Hayrettin Kesmezacar, Omer Uysal.
We hypothesized that combined peripheral nerve block (CPNB) technique might reduce mortality in hip fracture patients with the advantage of preserved cardiovascular stability. We retrospectively analyzed 257 hip fracture patients for mortality rates and affecting factors according to general anesthesia (GA), neuraxial block (NB), and CPNB techniques. Patients’ gender, age at admission, trauma date, ASA status, delay in surgery, followup period, and Barthel Activities of Daily Living Index were determined. There were no differences between three anesthesia groups regarding to sex, followup, delay in surgery, and Barthel score. NB patients was significantly younger and CPNB patients’ ASA status were significantly worse than other groups. Mortality was lower for regional group (NB + CPNB) than GA group. Mortality was increased with age, delay in surgery, and ASA and decreased with CPNB choice; however, it was not correlated with NB choice. Since the patients’ age and ASA status cannot be changed, they must be operated immediately. We recommend CPNB technique in high-risk patients to operate them earlier.
“Hip fracture” refers to a fracture of the femur in the area of bone immediately distal to the articular cartilage of the hip, to a level of about five centimeters below the lower border of the lesser trochanter . Hip fracture prevalence is rising with the continued ageing of the population . Studies have demonstrated the increased risk of mortality after hip fracture especially during the first year, and excess mortality risk may persist for several years after fracture [3–5]. 23.8% of patients die in the first year after hip fracture and one in three patients require a higher level of long-term care .
This study is approved by Istanbul University, Cerrahpasa Medical Faculty Research Ethics Committee. The records of all patients who underwent hip fracture surgery at our institution between January 1, 2000 and December 31, 2007 were reviewed. Previously ambulatory 65 years and older patients are included. All of the living patients were followed up for at least one year. Cancer patients and patients with insufficient preoperative data were excluded. Two hundred fifty-seven patients were included in the study.
Two hundred fifty-seven patients met the inclusion criteria and were included in the study. There were three groups of patients according to anesthesia techniques: 115 patients with GA, 50 patients with NB, and 92 patients with CPNB. The baseline characteristics of the study population according to anesthesia techniques are summarized in Table 1. There were no significant differences between three groups regarding to sex, mean followup, delay in surgery, and Barthel score. The patients mean age was 80.6 ± 8.3 for GA, 77.1 ± 7.8 for NB, and 81.0 ± 7.4 for CPNB (P = 0.013). NB group was significantly younger than the other two groups.
We retrospectively analyzed 257 hip fracture patients to determine mortality rates and factors affecting patient mortality, according to three anesthesia techniques.