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  2. Comparative safety of...
  3. Comparative safety of anesthetic type for hip fracture surgery in adults: retrospective cohort study
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Research

Comparative safety of anesthetic type for hip fracture surgery in adults: retrospective cohort study

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g4022 (Published 27 June 2014) Cite this as: BMJ 2014;348:g4022
  1. Elisabetta Patorno, instructor1,
  2. Mark D Neuman, assistant professor2,
  3. Sebastian Schneeweiss, professor1,
  4. Helen Mogun, programmer1,
  5. Brian T Bateman, assistant professor13
  1. 1Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02120, USA
  2. 2Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
  3. 3Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
  1. Correspondence to: E Patorno epatorno{at}partners.org
  • Accepted 11 June 2014

Abstract

Objective To evaluate the effect of anesthesia type on the risk of in-hospital mortality among adults undergoing hip fracture surgery in the United States.

Design Retrospective cohort study.

Setting Premier research database, United States.

Participants 73 284 adults undergoing hip fracture surgery on hospital day 2 or greater between 2007 and 2011. Of those, 61 554 (84.0%) received general anesthesia, 6939 (9.5%) regional anesthesia, and 4791 (6.5%) combined general and regional anesthesia.

Main outcome measure In-hospital all cause mortality.

Results In-hospital deaths occurred in 1362 (2.2%) patients receiving general anesthesia, 144 (2.1%) receiving regional anesthesia, and 115 (2.4%) receiving combined anesthesia. In the multivariable adjusted analysis, when compared with general anesthesia the mortality risk did not differ significantly between regional anesthesia (risk ratio 0.93, 95% confidence interval 0.78 to 1.11) or combined anesthesia (1.00, 0.82 to 1.22). A mixed effects analysis accounting for differences between hospitals produced similar results: compared with general anesthesia the risk from regional anesthesia was 0.91 (0.75 to 1.10) and from combined anesthesia was 0.98 (0.79 to 1.21). Findings were also consistent in subgroup analyses.

Conclusions In this large nationwide sample of hospital admissions, mortality risk did not differ significantly by anesthesia type among patients undergoing hip fracture surgery. Our results suggest that if the previously posited beneficial effect of regional anesthesia on short term mortality exists, it is likely to be more modest than previously reported.

Footnotes

  • Contributors: EP and BTB were involved in all parts of the study. HM was involved in data analysis and revising the manuscript. MDN and SS were involved in designing the study and revising the manuscript. All authors had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. EP and BTB are the guarantors.

  • Funding: This study was supported by the Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital and Harvard Medical School and by grants to MDN from the Foundation for Anesthesia Education and Research (Rochester, MN) and the National Institute on Aging (K08AG043548) and to BTB from the Eunice Kennedy Shriver National Institute Of Child Health & Human Development of the National Institutes of Health under Award No K08HD075831. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: SS is principal investigator of the Harvard-Brigham Drug Safety and Risk Management Research Center funded by the Food and Drug Administration. His work is partially funded by grants/contracts from the Patient-Centered Outcomes Research Institute, the FDA, and the National Heart, Lung, and Blood Institute; SS is consultant to WHISCON and LLC, and to Aetion, a software manufacturer of which he also owns shares, and he is principal investigator of investigator initiated grants to the Brigham and Women’s Hospital from Novartis and Boehringer-Ingelheim unrelated to the topic of this study.

  • Ethical approval: This study was approved by the institutional review board (No 2011P002580) of the Brigham and Women’s Hospital, Boston, MA, and a data use agreement was in place.

  • Data sharing: No additional data available.

  • Transparency: EP and BTB affirm that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/.

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