The Impact of Timing of Surgery and the Anesthesia Technique in Hip Fracture Surgery on In-hospital Mortality and Length of Hospital Stay

Gülay KIR, (Koç Üniversitesi Hastanesi, Yoğun Bakım Ünitesi, İstanbul, Türkiye)
Mehmet BUGET, (İstanbul Üniversitesi, İstanbul Tıp Fakültesi, Anesteziyoloji ve Yoğun Bakım Anabilim Dalı, İstanbul, Türkiye)
Kemalettin KOLTKA, (İstanbul Üniversitesi, İstanbul Tıp Fakültesi, Anesteziyoloji ve Yoğun Bakım Anabilim Dalı, İstanbul, Türkiye)
Mustafa Çağlar KIR, (Sağlık Bilimleri Üniversitesi Türkiye, Okmeydanı Eğitim ve Araştırma Hastanesi, Ortopedi ve Travmatoloji Kliniği, İstanbul, Türkiye)
Kamil PEMBECİ (İstanbul Üniversitesi, İstanbul Tıp Fakültesi, Anesteziyoloji ve Yoğun Bakım Anabilim Dalı, İstanbul, Türkiye)
JAREM
2 0
Yıl: 2020 Cilt: 10 Sayı: 1 Sayfa Aralığı: 82 - 87 Metin Dili: İngilizce DOI: 10.4274/jarem.galenos.2019.2076 İndeks Tarihi: 08-10-2020

The Impact of Timing of Surgery and the Anesthesia Technique in Hip Fracture Surgery on In-hospital Mortality and Length of Hospital Stay

Öz:
Objective: To point the positive impact of early surgery (performed within 48 hours) and non-general anesthesia techniques on early outcomes like inhospitalmortality 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 hospitalwith 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-twopatients (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 mortalitythan 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 ratesand 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 withunilateral spinal anesthesia. There were no deaths in 10 patients with 11.5 days of LOS, who received CSE anesthesia, while the mortality rate of theperipheral 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-generalanesthesia technique in order to reduce in-hospital mortality and LOS.
Anahtar Kelime:

Kalça Kırığı Cerrahisinde Cerrahinin Zamanlamasının ve Anestezi Tekniğinin Hastane İçi Mortalite ve Hastanede Yatış Süresine Etkisi

Öz:
Amaç: Erken cerrahinin (48 saat içinde yapılan) ve genel anestezi harici anestezi tekniklerinin hastane içi mortalite ve hastanede yatış süresi gibi erken dönem sonuçları üzerine olumlu etkilerini göstermektir. Yöntemler: Bu retrospektif çalışmaya kalça kırığı ile hastanemize başvuran 50 yaş ve üzerindeki 710 hasta dahil edildi, patolojik kırıklar ya da politravmatik yaralanmaları olan hastalar çalışmaya dahil edilmedi. Bulgular: Hastaların medyan yaşı 75,8±10,3 yıldı. Dör yüz altmış dokuzu (%66,1) kadındı. Altı yüz seksen iki hasta (%96,1) cerrahi olarak tedavi edildi, 16 hasta (%2,25) konservatif tedavi aldı ve 12 hasta (%1,7) planlanan ameliyattan önce öldü. Genel anestezi (n=328), spinal anestezi (n=268), tek taraflı spinal anestezi (n=47), periferik sinir bloğu (n=29) ve kombine spinal epidural (KSE) anestezi (n=10) cerrahide kullanılan anestezi teknikleridir. Kırk sekiz saat içinde tedavi edilen hastalar (G1) son zamanlarda tedavi edilen hastalara göre daha düşüktü (G2) (%0,8’e karşılık %4,7). G1 için LOS 8,6 gün iken G2 için 17,5 gün idi (p<0,001). Anestezi tekniklerinin mortalite oranları ve medyan LOS’ları: genel anestezi ile %5,5 ve 15 gün, spinal ile %2,2 ve 14 gün ve unilateral spinal anestezi ile %4,3 ve 13 gündü. On hastada ölüm olmamıştır. KSE anestezisi alan 11,5 günlük LOS hastası iken, periferal sinir bloğu grubunun mortalite oranı 10 günlük LOS ile %3,4 idi. Sonuç: Bu çalışma, mortalite ve LOS’u azaltmak için kırık kalçanın cerrahi onarımının ilk 48 saat içinde genel olmayan bir anestezi tekniği ile yapılması gerektiğini düşündürmektedir.
Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
  • 1. Meessen JM, Pisani S, Gambino ML, Bonarrigo D, Van Schoor NM, Fozzato S et al. Assessment of mortality risk in elderly patients after proximal femoral fracture. Orthopedics 2014; 37: 194-200.
  • 2. Pillai A, Eranki V, Shenoy R, Hadidi M. Age related incidence and early outcomes of hip fractures: a prospective cohort study of 1177 patients. J Orthop Surg Res 2011; 24: 6:5.
  • 3. Ekström W, Miedel R, Ponzer S, Hedström M, Samnegård E, Tidermark J. Quality of life after a stable trochanteric fracture – a prospective cohort study on 148 patients. J Orthop Trauma 2009; 23: 39-4.
  • 4. Shiga T, Tsuji Y, Fujioka M, Kubo T. Risk factors for hip fracture in Japanese elderly women with osteoporosis: Applicability of biochemical markers in bone turnover. Geriatr Gerontol Int 2009; 9: 69-4.
  • 5. Şenol Y, Akdeniz M. Yaşlılık ve Koruyucu Tıp. GeroFam 2010; 1: 49-68.
  • 6. Diamantopoulos AP, Hoff M, Hochberg M, Haugeberg G. Predictors of short and long-term mortality in males and females with hip fracture- a prospective observational cohort study. PLoSOne 2013; 8: e78169
  • 7. Shiga T, Wajima Z, Ohe Y. Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regression. Can J Anaesth 2008; 55: 146-54.
  • 8. González-Rozas M, Pérez-Castrillón JL, González-Sagrado M, Ruiz- Mambrilla M, García- Alonso M. Risk of mortality and predisposing factors after osteoporotic hip fracture: a one-year follow-up study. Aging Clin Exp Res 2012; 24: 181-7.
  • 9. Grønskag AB, Romundstad P, Forsmo S, Langhammer A, Schei B. Excess mortality after hip fracture among elderly women in Norway: the HUNT study. Osteoporos Int 2012; 23: 1807-11.
  • 10. Auffarth A, Resch H, Lederer S, Karpik S, Hitzl W, Bogner R et al. Does the choice of approach for hip hemiarthroplasty in geriatric patients significantly influence early postoperative outcomes? A randomizedcontrolled trial comparing the modified smith- petersen and hardinge approaches. J Trauma 2011; 70: 1257-62.
  • 11. Miller AG, Bercik MJ, Ong A. Nonagenarian hip fracture: Treatment and complications:J Trauma Acute Care Surg. 2012; 72: 1411-5.
  • 12. Ayoung-Chee P, McIntyre L, Ebel BE, Mack CD, McCormick W, Maier RV. Long-term outcomes of ground-level falls in the elderly: J Trauma Acute Care Surg 2014; 76: 498-503.
  • 13. Khan SK, Kalra S, Khanna A, Thiruvengada MM, Parker MJ. Timing of surgery for hip fractures: A systematic review of 52 published studies involving 291,413 patients. Injury 2009; 40: 692-7.
  • 14. Orosz GM, Magaziner J, Hannan EL, Morrison RS, Koval K, Gilbrt M et al. Association of timing of surgery for hip fracture and patient outcome. JAMA. 2004; 291: 1738-43.
  • 15. Scottish Intercollegiate Guidelines Network. prevention and management of hip fracture inolder people: A national clinical guideline. Edinburgh, UK: Scottish Intercollegiate Guidelines Network; 2002.
  • 16. British Orthopaedic Association Standarts for Trauma (BOAST): Hip fracture in the older person. September 2007.
  • 17. Simunovic N, Devereaux PJ, Sprague S, Guyatt GH, Schemitsch E, Debeer J et al. Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis. CMAJ 2010; 182: 1609-16.
  • 18. McGuire KJ, Bernstein J, Polsky D, Silber JH. Delays until surgery after hip fracture increases mortality. Clin Orthop Relat Res 2004; 428: 294-301.
  • 19. Dailiana Z, Papakostidou I, Varitimidis S, Michalitsis SG, Veloni A, Malizos KN. Surgical treatment of hip fractures: factors influencing mortality. Hippokratia 2013; 17: 252-7.
  • 20. Verbeek DOF, Ponsen KJ, Goslings JC, Heetveld MJ. Effect of surgical delay on outcome in hip fracture patients: a retrospective multivariate analysis of 192 patients. Int Orthop 2008; 32: 13-8.
  • 21. Kesmezacar H, Ayhan E, Unlu MC, Seker A, Karaca S. Predictors of mortality in elderly patients with an intertrochanteric or a femoral neck fracture. J Trauma 2010; 68: 153-8.
  • 22. Vidán MT, Sánchez E, Gracia Y, Marañón E, Vaquero J, Serra JA. Causes and effects of surgical delay in patients with hip fracture: a cohort study. Ann Intern Med. 2011; 155: 226-33.
  • 23. Librero J, Peiró S, Leutscher E, Merlo J, Bernal-Delgado E, Ridao M et al. Timing of surgery for hip fracture and in-hospital mortality: a retrospective population-based cohort study in the Spanish National Health System. BMC Health Serv Res 2012; 12: 15.
  • 24. Moran CG, Wenn RT, Sikand M, Taylor AM. Early mortality after hip fracture: is delay before surgery important? J Bone Joint Surg Am 2005; 87: 483-9.
  • 25. Novack V, Jotkowitz A, Etzion O, Porath A. Does delay in surgery after hip fracture lead to worse outcomes? A multicenter Survey. Int J Qual Health Care 2007; 19: 170-6.
  • 26. Anwar W, Rahman N, Khan A, Kashif S, Siraj M, Iqbal MJ et al. Relationship of preoperative surgical delay to mortality after hip fracture in elderly patients. Journal of Surgery Pakistan (International) 17 2012; 1: 20-3.
  • 27. Basques BA, Bohl DD, Golinvaux NS, Leslie MP, Baumgaertner MR, Grauer JN. Postoperative length of stay and thirty-day readmission following geriatric hip fracture: ann analysis of 8,434 patients. J Orthop Trauma 2014.
  • 28. Bergeron E, Lavoie A, Moore L, Bamvita JM, Ratte S, Gravel C, et al. Is the delay to surgery for isolated hip fracture predictive of outcome in efficient systems? J Trauma 2006; 60: 753-7.
  • 29. Ho V, Hamilton BH, Roos LL. Multiple approaches to assessing the effects of delays for hip fracture patients in the United States and Canada. Health Serv Res 2000; 34: 1499-518.
  • 30. Hamilton BH, Hamilton VH, Mayo NE. What are the costs of queuing for hip fracture surgery in Canada? J Health Econ 1996; 15: 161-85.
  • 31. Rodgers A, Walker N, Schug S, McKee A, Kehlet H, van Zundert A, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ 2000; 321 (7275): 1493.
  • 32. Luger TJ, Kammerlander C, Gosch M, Luger MF, Kammerlander-Knauer U, Roth T, et al. Neuroaxial versus general anaesthesia in geriatric patients for hip fracture surgery: does it matter? Osteoporos Int. 2010; 21(Suppl 4): 555-72.
  • 33. Karaca S, Ayhan E, Kesmezacar H, Uysal O. Hip Fracture Mortality: Is It Affected by Anesthesia Techniques? Anesthesiology Research and Practice 2012: 708754.
  • 34. O’Hara DA, Duff A, Berlin JA, Poses RM, Lawrence VA, Huber EC, et al. The effect of anesthetic technique on postoperative outcomes in hip fracture repair. Anesthesiology 2000; 92: 947-57.
  • 35. Le-Wendling L, Bihorac A, Baslanti TO, Lucas S, Sadasivan K, Wendling A et al. Regional anesthesia as compared with general anesthesia for surgery in geriatric patients with hip fracture: does it decrease morbidity, mortality, and health care costs? Results of a single-centered study. Pain Med 2012; 13: 948-56.
  • 36. Patorno E, Neuman MD, Schneeweiss S, Mogun H, Bateman BT. Comparative safety of anesthetic type for hip fracture surgery in adults: retrospective cohort study. BMJ. 2014; 348: g4022.
  • 37. Şahin SH, Heybeli N, Çolak A, Arar C, Alan K, Copuroglu C, et al. Comparison of different anesthetic techniques on postoperative outcomes in elderly patients with hip fracture. TurkiyeKlinikleri J Med Sci 2012; 32: 623-9.
  • 38. Liu JL, Wang XL, Gong MW, Mai HX, Pei SJ, Yuan WX, et al. Comparative outcomes of peripheral nerve blocks versus general anesthesia for hip fractures in geriatric Chinese patients.Patient Prefer Adherence 2014; 8: 651-9.
  • 39. Neuman MD, Rosenbaum PR, Ludwig JM, Zubizarreta JR, Silber JH. Anesthesia Technique, Mortality, and Length of Stay After Hip Fracture Surgery. JAMA 2014; 311: 2508-17.
APA KIR G, Buget M, Koltka K, Kir M, Pembeci K (2020). The Impact of Timing of Surgery and the Anesthesia Technique in Hip Fracture Surgery on In-hospital Mortality and Length of Hospital Stay. , 82 - 87. 10.4274/jarem.galenos.2019.2076
Chicago KIR GULAY,Buget Mehmet I.,Koltka Kemalettin,Kir Mustafa Caglar,Pembeci Kamil The Impact of Timing of Surgery and the Anesthesia Technique in Hip Fracture Surgery on In-hospital Mortality and Length of Hospital Stay. (2020): 82 - 87. 10.4274/jarem.galenos.2019.2076
MLA KIR GULAY,Buget Mehmet I.,Koltka Kemalettin,Kir Mustafa Caglar,Pembeci Kamil The Impact of Timing of Surgery and the Anesthesia Technique in Hip Fracture Surgery on In-hospital Mortality and Length of Hospital Stay. , 2020, ss.82 - 87. 10.4274/jarem.galenos.2019.2076
AMA KIR G,Buget M,Koltka K,Kir M,Pembeci K The Impact of Timing of Surgery and the Anesthesia Technique in Hip Fracture Surgery on In-hospital Mortality and Length of Hospital Stay. . 2020; 82 - 87. 10.4274/jarem.galenos.2019.2076
Vancouver KIR G,Buget M,Koltka K,Kir M,Pembeci K The Impact of Timing of Surgery and the Anesthesia Technique in Hip Fracture Surgery on In-hospital Mortality and Length of Hospital Stay. . 2020; 82 - 87. 10.4274/jarem.galenos.2019.2076
IEEE KIR G,Buget M,Koltka K,Kir M,Pembeci K "The Impact of Timing of Surgery and the Anesthesia Technique in Hip Fracture Surgery on In-hospital Mortality and Length of Hospital Stay." , ss.82 - 87, 2020. 10.4274/jarem.galenos.2019.2076
ISNAD KIR, GULAY vd. "The Impact of Timing of Surgery and the Anesthesia Technique in Hip Fracture Surgery on In-hospital Mortality and Length of Hospital Stay". (2020), 82-87. https://doi.org/10.4274/jarem.galenos.2019.2076
APA KIR G, Buget M, Koltka K, Kir M, Pembeci K (2020). The Impact of Timing of Surgery and the Anesthesia Technique in Hip Fracture Surgery on In-hospital Mortality and Length of Hospital Stay. JAREM, 10(1), 82 - 87. 10.4274/jarem.galenos.2019.2076
Chicago KIR GULAY,Buget Mehmet I.,Koltka Kemalettin,Kir Mustafa Caglar,Pembeci Kamil The Impact of Timing of Surgery and the Anesthesia Technique in Hip Fracture Surgery on In-hospital Mortality and Length of Hospital Stay. JAREM 10, no.1 (2020): 82 - 87. 10.4274/jarem.galenos.2019.2076
MLA KIR GULAY,Buget Mehmet I.,Koltka Kemalettin,Kir Mustafa Caglar,Pembeci Kamil The Impact of Timing of Surgery and the Anesthesia Technique in Hip Fracture Surgery on In-hospital Mortality and Length of Hospital Stay. JAREM, vol.10, no.1, 2020, ss.82 - 87. 10.4274/jarem.galenos.2019.2076
AMA KIR G,Buget M,Koltka K,Kir M,Pembeci K The Impact of Timing of Surgery and the Anesthesia Technique in Hip Fracture Surgery on In-hospital Mortality and Length of Hospital Stay. JAREM. 2020; 10(1): 82 - 87. 10.4274/jarem.galenos.2019.2076
Vancouver KIR G,Buget M,Koltka K,Kir M,Pembeci K The Impact of Timing of Surgery and the Anesthesia Technique in Hip Fracture Surgery on In-hospital Mortality and Length of Hospital Stay. JAREM. 2020; 10(1): 82 - 87. 10.4274/jarem.galenos.2019.2076
IEEE KIR G,Buget M,Koltka K,Kir M,Pembeci K "The Impact of Timing of Surgery and the Anesthesia Technique in Hip Fracture Surgery on In-hospital Mortality and Length of Hospital Stay." JAREM, 10, ss.82 - 87, 2020. 10.4274/jarem.galenos.2019.2076
ISNAD KIR, GULAY vd. "The Impact of Timing of Surgery and the Anesthesia Technique in Hip Fracture Surgery on In-hospital Mortality and Length of Hospital Stay". JAREM 10/1 (2020), 82-87. https://doi.org/10.4274/jarem.galenos.2019.2076
Sayfa Oluşturulma Tarihi
25-04-2024 3:17

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