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Local Anesthesia Better for Hip-Fracture Surgery

General anesthesia may not always be best for patients undergoing hip-fracture surgery, a study has found.

The researchers, from the Perelman School of Medicine at the University of Pennsylvania, found in another study that there were high rates of mortality and functional disability among nursing-home residents who were treated for hip fracture.

Each year, about 300,000 hip fractures occur in the United States. They often happen as a result of serious falls that can impair functionality.

The anesthesia study, published in JAMA, used a new research technique for comparing the effectiveness of different kinds of anesthesia on patients who had hip fractures.

“This is a problem that is likely to become progressively more important as the population ages,” says Mark Neuman, MD, MSc, lead author on both studies and assistant professor of Anesthesiology. “We wanted to understand to what degree anesthesia played a role in outcomes after hip fracture surgery. A key innovation of this study was its use of new statistical methods to address biases created by the fact that patients who receive regional anesthesia tend to be older and sicker than those treated with general anesthesia.”

Current guidelines call for broader use of regional anesthesia.

In the JAMA study, the Penn team looked at 56,729 patients, all over 50, who were hospitalized with a hip fracture between 2004 and 2011. Of these, 15,904 (28 percent) received regional anesthesia, and 40,825 (72 percent) received general anesthesia during surgery.

As a result of their analysis, researchers found a greater difference in length of hospital stay, with regional anesthesia patients staying six days, as opposed to 6.3 days for patients who received general anesthesia.
In the second study, published in JAMA Internal Medicine, the team analyzed the patterns among nursing-home patients of survival and dependence on the use of walkers, canes, and other walking assist devices at six months and one year following hip fracture. They also looked at changes in the patients’ ability to perform essential activities of daily living.

Hip fracture was found to be associated with substantially higher death rates and dependency in performing daily tasks. By 180 days postfracture, more than one in three patients had died. Among patients who were fully independent or required limited assistance with movement before their injury, one in five survived to regain their prefracture level of independence 180 days later.

This study, the researchers report, is the largest and most comprehensive to date on outcomes following hip fracture among nursing home residents.

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