Spinal anesthesia with better outcome in geriatric hip fracture surgery - An analysis of the Registry for Geriatric Trauma (ATR-DGU)

Bastian Pass; Tom Knauf; Matthias Knobe; Katherine Rascher; Christopher Bliemel; Alexander Maslaris; Rene Aigner; Daniel Dirkmann; Sven Lendemans; Carsten Schoeneberg; Registry for Geriatric Trauma (ATR-DGU)

doi:10.1016/j.injury.2023.04.001

Spinal anesthesia with better outcome in geriatric hip fracture surgery - An analysis of the Registry for Geriatric Trauma (ATR-DGU)

Injury. 2023 Apr 5:S0020-1383(23)00298-X. doi: 10.1016/j.injury.2023.04.001. Online ahead of print.

Affiliations

¹ Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, Essen, Germany. Electronic address: bastian.pass@krupp-krankenhaus.de.
² Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany. Electronic address: knauft@med.uni-marburg.de.
³ Medical Faculty, University of Zurich, Zurich, Switzerland; Medical Faculty, RWTH Aachen University Hospital, Aachen, Germany. Electronic address: matthias.knobe@uzh.ch.
⁴ AUC - Academy for Trauma Surgery (AUC), Munich, Germany. Electronic address: katherine.rascher@auc-online.de.
⁵ Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany. Electronic address: bliemel@med.uni-marburg.de.
⁶ Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, Essen, Germany. Electronic address: alexander.maslaris@krupp-krankenhaus.de.
⁷ Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany. Electronic address: aignerr@med.uni-marburg.de.
⁸ Department of Anesthesiology, Intensive Care and Pain Medicine, Alfried Krupp Hospital Essen, Germany. Electronic address: daniel.dirkmann@krupp-krankenhaus.de.
⁹ Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, Essen, Germany. Electronic address: sven.lendemans@krupp-krankenhaus.de.
¹⁰ Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, Essen, Germany. Electronic address: carsten.schoeneberg@krupp-krankenhaus.de.
¹¹ Working Committee on Geriatric Trauma Registry of the German Trauma Society (DGU), Berlin, Germany.

PMID: 37032184
DOI: 10.1016/j.injury.2023.04.001

Abstract

Background: Literature shows conflicting results regarding spinal (SA) or general anesthesia (GA) and their influence on the outcome of elderly patients with hip fractures. We, therefore, conducted an analysis from the Registry for Geriatric Trauma (ATR-DGU).

Methods: A retrospective, multicenter registry study including patients aged 70 years or above with hip fractures requiring surgery from 131 Centers for Geriatric Trauma (AltersTraumaZentrum DGU®) from 2016 to 2021. Patients with SA or GA were compared using matched-pair analysis and linear and logistic regression models.

Results: A total of 43,714 patients were included, of whom 3,242 received SA. The median age was 85 (SA) and 84 years (GA). Adjustments for the American Society of Anesthesiologists (ASA) grade, sex, age, additional injuries, and anticoagulation resulted in a higher in-hospital (odds ratio (OR) 1.31; 95% confidence interval [CI], 1.07 - 1.61, p = 0.009) and 120 days mortality (OR 1.47; 95% CI, 1.1 - 1.95, p = 0.009) in the GA group. GA had a significant negative influence on walking ability seven days after surgery and on the quality of life (QoL). The length of hospital stay (LoS) was significantly shorter in the SA group.

Conclusions: SA is associated with a higher survival rate, a better walking ability seven days after surgery, a higher QoL, and a shorter LoS.

Keywords: Anesthesia; Frailty; Geriatric trauma; Hip fracture; Orthogeriatric.