The impact of timing of surgery and the anesthesia technique in hip fracture surgery on in-hospital mortality and length of hospital stay

Abstract

Objective: to point the positive impact of early surgery (performed within 48 hours) and non-general anesthesia techniques on early outcomes like in-hospital mortality and length of hospital stay (LOS). Methods: seven hundred and ten patients were included in this retrospective study. Patients aged 50 years and over, who were admitted to our hospital with hip fracture, were included, while the patients with pathological fractures or polytraumatic injuries were excluded. Results: the median age of the patients was 75.8 +/- 10,.3 years. Four hundred and sixty-nine (66.1%) patients were female. Six hundred and eighty-two patients (96.1%) were treated surgically, 16 patients (2.25%) received conservative treatment and 12 patients (1.7%) died before scheduled surgery. General anesthesia (n=328), spinal anesthesia (n=268), unilateral spinal anesthesia (n=47), peripheral nerve block (n=29), and combined spinal-epidural (CSE) anesthesia (n=10) were the anesthesia techniques used for surgery. Patients who were treated within 48 hours (G1) had lower in-hospital mortality than the patients who were treated lately (G2) (0.8% vs 4,7%). The LOS for G1 was 8.6 days whereas it was 17.5 days for G2 (p<0.001). Mortality rates and median LOS of the anesthesia techniques were 5.5% and 15 days with general anesthesia, 2.2% and 14 days with spinal, and 4.3% and 13 days with unilateral spinal anesthesia. There were no deaths in 10 patients with 11.5 days of LOS, who received CSE anesthesia, while the mortality rate of the peripheral nerve block group was 3.4% with 10 days of LOS. Conclusion: the results of this study suggest that the surgical repair of the fractured hip should be performed within the first 48 hours, with a non-general anesthesia technique in order to reduce in-hospital mortality and LOS.