OTA 1997 Posters - Hip Fractures

Functional Outcome after Hip Fracture: The Effect of General vs Regional Anesthesia

Kenneth J. Koval, MD, Gina Aharonoff, MPH, Kenneth A. Egol, MD, Andrew Rosenberg, MD, Ralph Bernstein, MD, Joseph D. Zuckerman, MD

New York, New York, USA

Purpose: Although scant information is available on the effect of anesthesia on functional outcome after hip fracture, a recent study has suggested that elderly hip fracture patients have a better functional result if surgery is performed under general rather than regional anesthesia. The purpose of this prospective study was to determine whether anesthetic technique has an effect on functional recovery and ambulation in a series of community-dwelling ambulatory elderly hip fracture patients, while controlling for potential confounding variables.

Methods: From July 1987 to December 1994, 655 community-dwelling patients over the age of 65 who had an operatively treated femoral neck or intertrochanteric fracture of nonpathologic origin and did not have a preselected anesthetic technique were prospectively followed. All patients were identified at the time of admission, followed a similar postoperative protocol and were contacted at 3, 6, and 12 months after surgery. Functional outcome at follow-up was determined by an 11-item functional rating scale that assesses independence in activities of daily living and mobility. In addition, an in-depth evaluation of the patient's ambulatory ability (seven possible ambulatory levels) was performed. Statistical analysis was performed to examine whether anesthetic type (general or spinal) had an effect on functional outcome at 3, 6, or 12 months after surgery. Functional recovery at each time period was defined as the percent change of the prefracture score. The following were held as confounding variables: age, sex, fracture type, number of preinjury medical comorbidities, ASA rating of operative risk, prefracture function, type of surgery, and postoperative complications.

Results: Sixty-eight patients died during the first year following hip fracture and an additional 85 patients refused to participate or were lost to follow-up. Therefore, 502 patients (77%) remained for whom complete follow-up information was available; 276 patients (55%) had general and 226 (45%) spinal anesthesia. Mean functional rating score was 83.6 prefracture, 57.5 at 3 months, 67.6 at 6 months, and 69.5 at 12 months. In univariate analysis, percent functional recovery was significantly higher at 6 months for patients who had general anesthesia (p < .05). When controlling for potential confounding variables, however, no differences were observed in percent functional recovery between the two groups at 3, 6, or 12 months following hip fracture. There were no differences in recovery in ambulatory ability between the two groups of patients in either univariate or multivariate analysis at 3, 6, or 12 months following surgery.

Discussion and Conclusion: In this study, no differences in functional recovery were found between elderly hip fracture patients who had regional or general anesthesia. These results are similar to those regarding the effect of anesthetic technique on mortality or postoperative mental status in elderly patients undergoing hip fracture surgery. This study provides valuable information that can be used to counsel patients and their families regarding the risks and benefits of regional vs. general anesthesia prior to hip fracture surgery.