Effect of Spinal Versus General Anesthetic on 30-Day Outcomes in Patients With Chronic Obstructive Pulmonary Disease Undergoing Hip Arthroplasty for Femoral Neck Fracture.

Introduction: Patients with chronic obstructive pulmonary disease (COPD) and femoral neck fractures are at high risk for postoperative complications and mortality. One consideration to reduce risk is the type of anesthesia, although this has not been investigated. The purpose of this study was to compare 30-day complications between use of general and spinal anesthetic in patients with COPD and femoral neck fractures who underwent hip arthroplasty.

Methods: Patients with COPD treated with hip arthroplasty for femoral neck fractures were identified on the American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) database between January 1, 2015 and December 31, 2020. Demographics, patient variables, and surgical variables were recorded. Patients were divided into cohorts based on general or spinal anesthetic. Propensity score matching was used to match the two groups. Thirty-day outcome measures were compared between groups using chi-squared test. Logistic regression was used to assess for risk factors for 30-day complications.

Results: Five thousand and forty patients with COPD were identified who underwent arthroplasty for femoral neck fracture-3800 with general anesthesia and 1240 patients with spinal anesthesia. The general anesthesia cohort had higher rates of diabetes (18.4% vs. 15.1%, p = 0.007), congestive heart failure (10.7% vs. 6.7%, p < 0.001), and chronic kidney disease requiring dialysis (2.6% vs. 1.5%. p = 0.019). After matching, the general anesthesia cohort had higher rates of mortality (8.4% vs. 5.8%, p = 0.042), nonhome discharge (85.5% vs. 79.2%, p < 0.001), and unplanned intubation (1.9% vs. 0.7%, p = 0.048). Logistic regression identified general anesthesia to be an independent risk factor for 30-day mortality (RR 1.514 [1.022-2.245]), nonhome discharge (1.626 [1.237-2.138]), and unplanned intubation (RR 1.488 [1.012-2.187]).

Conclusions: General anesthesia is an independent risk factor for 30-day mortality, nonhome discharge, and unplanned intubation in patients with COPD undergoing arthroplasty procedures for femoral neck fractures. If possible, spinal anesthetic should be considered as it may reduce the risk of complications in this patient population.