Contrary to popular belief, older people who receive general anesthesia during hip fracture surgery have better long-term outcomes than those who have spinal anesthesia, according to a new study conducted by doctors at the University of Maryland Medical Center. The study is the largest one to assess outcomes following hip fracture surgery. The results are published in the American Journal of Orthopedics, January issue.
"Doctors prescribe spinal anesthesia more often for their elderly patients thinking that it is safer than general anesthesia in which the entire body is put to sleep," says Timothy Gilbert, M.D., director of cardiothoracic anesthesiology at the University of Maryland Medical Center and lead investigator of the study. "But we found that patients who received general anesthesia for their hip fracture repair were able to walk without help and able to perform daily activities with greater ease than those who received spinal anesthesia," says Dr. Gilbert who is also an associate professor of anesthesiology at the University of Maryland School of Medicine.
The two-year study followed 741 elderly patients who had surgery at eight Baltimore hospitals. The patients were interviewed in the hospital after their hip fracture repair to assess how well they were able to function before their fracture. Out-of-hospital evaluations were repeated at two, six, 12, 18 and 24 months, using a portable gait measure and other measures of function. Participants also answered questions about their ability to perform daily living activities. Of the patients enrolled, 430 received spinal anesthesia and 311 received general anesthesia.
"More than 300, 000 people in the United States over age 65 will fracture a hip this year, says Jay S. Magaziner, Ph.D., professor and director of the division of gerontology, Department of Epidemiology and Preventive Medicine at the University of Maryland School of Medicine. "Of this group, up to 33 percent will die within one year of their fractures, and more than half of others who survive will experience reduced mobility and have problems functioning independently."
This study, part of the Baltimore Hip Studies Program, was conducted to find ways to improve the outcome for this group of patients. Through observation and interviews, researchers attempted to identify factors that directly impacted how well these patients recovered. The choice of anesthetic for hip fracture repair appeared to have a significant impact on the outcome, although the researchers are not sure why.
"We think that some subtle nerve damage may occur when patients get the spinal anesthetic administered, either from the needle or from the concentrated dose of medication in one location," says Dr. Gilbert. "It's something that needs further investigation, but these results show there is clearly a relationship between the type of anesthesia used for hip fracture repair and how well patients do later."
The study, funded by grants from the National Institutes of Health and the Agency for Health Care Policy & Research, was the first to follow such a large group of patients for a two-year period. Other studies of anesthetic techniques for hip fracture repair have only focused on short-term outcome, less than three months following surgery.
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