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

• Published in: Injury Vol. 54; no. 6; pp. 1756 - 1762
• Main Authors: Pass, Bastian, Knauf, Tom, Knobe, Matthias, Rascher, Katherine, Bliemel, Christopher, Maslaris, Alexander, Aigner, Rene, Dirkmann, Daniel, Lendemans, Sven, Schoeneberg, Carsten
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.06.2023
• Subjects: Anesthesia; Frailty; Geriatric trauma; Hip fracture; Orthogeriatric; Anesthesia; Frailty; Hip fracture; Orthogeriatric; Geriatric trauma
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2023.04.001

•The level of evidence in the perioperative management of elderly trauma patients is poor.•A comparison between spinal and general anesthesia from the Geriatric Trauma Registry of the German Trauma Society (DGU®) was conducted.•Spinal anesthesia does not extend time to surgery.•Patients with spinal anesthesia had a significantly lower mortality rate and a better quality of life.•Patients with spinal anesthesia had a better walking ability on the seventh day after surgery and a shorter length of stay in hospital. 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). 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. 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. SA is associated with a higher survival rate, a better walking ability seven days after surgery, a higher QoL, and a shorter LoS.