Neuraxial Compared With General Anesthesia on Postoperative Outcomes After Hip Arthroplasty for Geriatric Hip Fracture: Results From a National Database.

Abstract

BACKGROUND Anesthesia choice affects hip fracture surgery outcomes. However, limited evidence exists regarding the impact of neuraxial anesthesia (NA) versus general anesthesia (GA) on postoperative outcomes, specifically in hip arthroplasty for fracture. The purpose of this study was to compare 30-day readmission, in-hospital complications, hospitalization charges, and length of stay between the elderly who received NA and GA during this procedure. METHODS The Hospital Quality Monitoring System was analyzed for patients undergoing hip arthroplasty for geriatric hip fracture (≥60 years of age) between 2013 and 2019. After adjusting for potential confounders with propensity score matching, logistic regression and linear regression analyses were conducted to compare NA with GA in terms of 30-day readmission rates and causes, in-hospital complications (including in-hospital mortality, pulmonary embolism, deep vein thrombosis, wound infection, and blood transfusion), hospitalization charges, and length of stay. RESULTS Of the 90,745 patients undergoing hip arthroplasty for geriatric hip fracture during the study period (40,551 [44.7%] for NA, 50,194 [55.3%] for GA), a total of 62,022 patients (31,011 propensity score-matched pairs) were included after study exclusions and propensity score matching. NA was significantly associated with a lower incidence of 30-day readmission (4.60% vs 4.97%, odds ratio [OR] = 0.92, 95% confidence interval [CI], 0.86-0.99, P =.032) and fewer genitourinary system complaints (0.18% vs 0.26%, OR = 0.70, 95% CI, 0.50-0.97, P =.035) for readmission compared with GA. The incidence of in-hospital mortality (0.41% vs 0.64%, OR = 0.64, 95% CI, 0.52-0.81, P <.001), deep vein thrombosis (1.84% vs 2.57%, OR = 0.71, 95% CI, 0.64-0.79, P <.001), and pulmonary embolism (0.22% vs 0.38%, OR = 0.58, 95% CI, 0.43-0.79, P <.001) was also lower for NA compared with GA. Moreover, patients with NA had decreased charges (49,851.8 Chinese Yuan [CNY] vs 54,754.8 CNY, P <.001) relative to GA. The length of stay did not differ significantly between NA and GA (13.7 days vs 13.8 days, P =.217). CONCLUSIONS In geriatric patients undergoing hip arthroplasty for hip fracture, NA is associated with lower rates of 30-day readmission, fewer readmission caused by genitourinary system complaints, reduced complications, and decreased hospitalization charges compared to GA.