Safest Anesthetic Technique for Hip Fractures in Elderly
Osama Yahya Ahmed Khalifa*
Department of anesthesia, Zagazig University, Egypt
Submission: February 19, 2017;; Published: June 01, 2017
*Corresponding author: Osama Yahya Ahmed Khalifa, Department of anesthesia, Zagazig University, Egypt, Tel: 00201007579438; Email: osamayehiaahmadkhalifa@gmail.com; yehia2001@hotmail.com
How to cite this article: Osama Yahya Ahmed Khalifa. Safest Anesthetic Technique for Hip Fractures in Elderly. J Anest & Intern Care Med. 2017; 2(5) : 555600. DOI: 10.19080/JAICM.2017.02.555600
Background
There is high incidence of perioperative complications in hip surgeries after femoral neck fractures in older age group.
Objective
In this review, we try to detect the safest anesthetic technique for those patients.
Introduction
Hip fracture is a worldwide problem affecting 1.6million and will affect 2.6 annually by 2025 [1].Hip fractures are associated with high risk of morbidity and mortality, approximately 1-6% of patients will die during their hospital stay [2-4], 4-10% will die with in 30 days of their admission [5], and 18%- 28% of the patients die with in one year of their fractures [6] this is mainly due to pulmonary and cardiovascular complications [7]. Postoperative delirium is a frequent complication in elderly patients with hip fractures and the incidence is varying between 16% and 62% [8]. Patients with femoral neck fracture can experience delirium three times more than patients undergoing non orthopedic surgery [9]. Postoperative delirium is associated with high morbidity and mortality and prolonged hospitalization with subsequent increased suffering and cost [10]. There are many risk factors associated with postoperative morbidity and mortality in such age group of patients. Adequate preoperative treatment of respiratory problems (COPD, asthma) and prevention of postoperative cardiovascular complications (hypotension, hypertension, arrhythmia, ischemia, heart failure) may be the most important factor in reducing postoperative mortality after hip fracture surgery [11]. Cardiovascular, respiratory and neurological complications are well correlated to age, preoperative bedridden state, neurological comorbidities, preoperative delirium, and frequent intraoperative hypotension.
Anesthesia type
The influence of anesthesia type on mortality and morbidity in hip fracture surgery is certainly a controversial issue in the literature. Regional anesthesia has significantly reduced incidences of deep venous thrombosis, surgical site infection, pulmonary complications, and amount of blood loss. General anesthesia has a lower incidence of hypotension and cerebrovascular accidents [12]. A retrospective cohort study based on a nation wide sample of hospital admissions found that, there was no significant difference in risk of mortality with type of anesthesia in patients undergoing hip fracture surgery [13]. Regarding thirty days mortality another study found that, spinal anesthesia was associated with significantly lower incidence of thirty days complications than general anesthesia in hip fracture surgery [14]. Liu et al. [15] found that there was no significant difference in post-operative mortality and complications between general anesthesia and peripheral nerve blocks in these cases [15]. Jin et al. [16] found that there was no significant difference between peripheral nerve blocks and epidural anesthesia in hip fracture surgery regarding postoperative mortality and complications [16]. Continuous spinal anesthesia and ultrasound guided combined psoas compartment-sciatic nerve block (PCSNB) produced satisfactory quality of anesthesia in elderly high risk patients of hip replacement surgery but hemodynamic changes were fewer in us guided PCSNB [17].
Conclusion
A variety of appropriate anesthetic techniques can be used according to the patient individual condition regarding patient choice, comorbidities, psychological make up, anesthetist previous experience, surgical procedure, hospital facilities including funds available and postoperative care.
References
- Gullberg B, Johnell O, Kanis JA (1997) Worldwide projections for hip fractures. Osteoporos Int 7(5): 407-413.
- O'Hara DA, Duff A, Berlin JA, Poses RM, Lawrence VA, et al. (2000) The effect of anesthetic technique on postoperative outcomes in hip fracture repair. Anesthesiology 92(4): 947-957.
- Radcliff TA, Henderson WG, Stoner TJ, Khuri SF, Dohm M, et al. (2008) Patient risk factors, operative care, and outcomes among older community-dwelling male veterans with hip fracture. J Bone Joint Surg Am 90(1): 34-42.
- Neuman MD, Silber JH, Elkassabany NM, Ludwig JM, Fleisher LA (2012) Comparative effectiveness of regional versus general anesthesia for hip fracture surgery in adults. Anesthesiology 117(1): 72-92.
- Roche JJ, Wenn RT, Sahota O, Moran CG (2005) Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. BMJ 331(7521): 1374.
- Wehren LE, Magazine J (2003) Hip fracture: risk factors and outcomes. Curr Osteoporos Rep 1(2): 78-85.
- Lawrence VA, Hilsenbeck SG, Noveck H, Poses RM, Carson JL (2002) Medical complications and outcomes after hip fracture repair. Arch Intern Med 162(18): 2053-2057.
- O'keef ST, Ni CA (1994) Postoperative delirium in the elderly. Br J Anaesth 73(5): 673-687.
- Jagmin MG (1998) Postoperative mental status in elderly hip surgery patients. Ortho Nurs 17(6): 32-42.
- Nightingale S, Holmes J, Mason J, House A (2001) Psychiatric illness and mortality after hip fracture. Lancet 357(9264): 1264-1265.
- Kim BH, Lee S, Yoo B, Lee WY, Lim Y, et al. (2015) Risk factors associated with outcomes of hip fracture surgery in elderly patients. Korean Journal of Anesthesiology 68(6): 561-567.
- Neuman MD, Silber JH, Elkassabany NM, Ludwig JM, Fleisher LA (2012) Comparative effectiveness of regional versus general anesthesia for hip fracture surgery in adults. Anesthesiology 117(1): 72-92.
- Patorno E, Neuman MD, Shneeweiss S, Mogun H, Bateman BT (2014) comparative safety of anesthetic type for hip fracture surgery in adults: retrospective cohort study. BMJ 348: g4022.
- Adam CF, James DD, Buterbaugh K, Moucha CS (2015) Short term complications in hip fracture surgery using spinal versus general anesthesia. Injury 46(4): 719-723.
- Liu JL, Wang XL, Gong MW, Mai HX, Pei SJ, et al. (2014) Comparative outcomes of peripheral nerve blocks versus general anesthesia for hip fractures in geriatric Chinese patients. Patient Prefer Adherence 8: 651-659.
- Jin J, Wang G, Going M, Zhang H, Liu J, et al. (2015) Retrospective comparison of the effects of epidural anesthesia versus peripheral nerve block on postoperative outcomes in elderly Chinese patients with femoral neck fractures. Clin Interv Aging 10: 1223-1231.
- Aksoy M, Dostbil A, InceI, Ahiskalioglu A, Alici HA, et al. (2014) Continuous spinal anaesthesia versus ultrasound guided combined psoas compartment- sciatic nerve block for hip replacement surgery in elderly high-risk patients: a prospective randomized study. BMC Anesthesiology 14: 99.