Orthopedic surgeons and anesthesiologists have teamed up to examine which types of anesthesia have the lowest mortality rate and fewest complications.
Their study, “Is Anesthesia Technique Associated With a Higher Risk of Mortality or Complications Within 90 Days of Surgery for Geriatric Patients With Hip Fractures?” was published in the June 2018 issue of Clinical Orthopaedics and Related Research.
Chunyuan Qiu, M.D., with the Department of Anesthesiology at the Kaiser Permanente Baldwin Park Medical Center and co-author commented to OTW, “After years of practice, it was more evident that ‘short’ exposure to anesthetics was having long-lasting effects.”
“For example, intraoperative anesthesia management can influence the cancer recurrence, surgical site infection, and cognitive function, etc. We planned study to answer a simple question: Do various anesthesia techniques make a difference in patient’s clinical outcomes with today’s medicine?’”
The authors wrote, “We conducted a retrospective study on geriatric patients (65 years or older) with hip fractures between 2009 and 2014 using the Kaiser Permanente Hip Fracture Registry…The final study sample consisted of 16,695 patients…”
Dr. Qiu told OTW, “We found that different anesthesia techniques have different mortality and morbidity profiles in elderly traumatic hip fracture patients who need emergency surgery, which was not seen before for multiple reasons. Because we were able to systematically analyze a large population, our results shed new light: regional anesthesia has the lowest mortality rate as compared to other techniques such as general anesthesia.”
“Whenever possible, regional anesthesia (neuraxial anesthesia and regional blocks) should be considered as the preferred methods for the elderly fragile hip fracture surgeries. The choice your anesthesiologist makes for your hip fracture patients can influence your surgical outcomes. Therefore, as the leader of the care team, you should participate in the decision-making process.”
we have not been able to purchase spinal kits for the past six months. We have been able to find some spinal marcaine but no kits of any kind. preservative free epi is also very difficult (and expensive) to obtain. The argument between regional and general is mote when the materials to provide spinal anesthesia are no longer available or only at an exorbitant price. Are others out there having the same problems?
We are also not able to obtain spinal anesthesia kits or spinal bupivacaine. We have had to revert to using epidural trays, dropping a sterile 25 gauge or 22 gauge spinal needle, and using off-label preservative-free 0.5 % bupivacaine. This works in the patients that don’t have absolute contraindications to neuroaxial anesthesia.
As an anesthesiologist I find the biggest problem with this type of research is that surgeons read it and think it gives them license to dictate what type of anesthesia to give. While data may show that regional is generally safer, there are patients for whom regional is not an option or not preferable. These seem to be the very patients to whom the surgeon has already spoken saying “We’ll do a spinal on you because that’s so much safer.” leaving me to explain why it’s NOT a good idea for this particular patient and having the inevitable argument with the patient saying “BUT MY DOCTOR SAID” It also tends to lead to the internists sprinkling the charts with notes saying “Patient cleared for spinal anesthesia.”
Couldn’t have agreed more. 5 🌟