Retrospective Cohort Study
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World J Clin Cases. Mar 26, 2022; 10(9): 2721-2732
Published online Mar 26, 2022. doi: 10.12998/wjcc.v10.i9.2721
Association between anesthesia technique and complications after hip surgery in the elderly population
Ling-Song Guo, Li-Nan Wang, Jian-Bing Xiao, Min Zhong, Gao-Feng Zhao
Ling-Song Guo, Li-Nan Wang, Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510000, Guangdong Province, China
Jian-Bing Xiao, Min Zhong, Gao-Feng Zhao, Department of Anaesthesiology, Guangdong Provincial Hospital of Chinese Medicine (the Second Affiliated Hospital of Guangzhou University of Chinese Medicine), Guangzhou 510000, Guangdong Province, China
Author contributions: Guo LS and Wang LN contributed equally to this work; Guo LS, Wang LN, Zhao GF, Xiao JB, Zhong M designed research; Guo LS, Wang LN, Zhao GF performed research; Guo LS, Zhao GF, Xiao JB contributed new analytic tools; Guo LS and Wang LN analyzed data; Guo LS and Zhong M wrote the paper.
Institutional review board statement: The study was reviewed and approved by the [Ethics Committee of Guangdong Provincial Chinese Hospital, Guangzhou, China (Chairperson Prof J. Liu)] Institutional Review Board (Ethics approval number: ZE2020-288-01).
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at email address. Participants gave informed consent was not obtained but the presented data are anonymized and risk of identification is low for data sharing.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) 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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Gao-Feng Zhao, MD, Doctor, Department of Anaesthesiology, Guangdong Provincial Hospital of Chinese Medicine (the Second Affiliated Hospital of Guangzhou University of Chinese Medicine), No.111 Dade Road, Guangzhou 510000, Guangdong Province, China. zhaogaofengzyy@163.com
Received: October 10, 2021
Peer-review started: October 10, 2021
First decision: December 10, 2021
Revised: December 24, 2021
Accepted: February 12, 2022
Article in press: February 12, 2022
Published online: March 26, 2022
Processing time: 163 Days and 10.3 Hours
Abstract
BACKGROUND

Spinal anesthesia is superior to general anesthesia for postoperative recovery in older patients (≥ 65 age). However, evidence for this is lacking.

AIM

To evaluate the effect of anesthesia on postoperative complications in older patients undergoing hip surgery.

METHODS

This is a retrospective, propensity score-matched, cohort study. Patients ≥ 65-years-old who underwent hip surgery at the Traditional Chinese Medicine of Guangdong Provincial Hospital in China from October 2016 to June 2020 were included. The operative methods were femoral fracture’s internal fixation and hip replacement. The orthopedic doctors in different hospitals of our group have varied requirements for patients’ out-of-bed time after surgery. Therefore, spinal anesthesia or general anesthesia was selected according to the requirements of the orthopedic doctors. The primary outcome of this study was complications during the hospitalization of the postoperative patient. The length of hospital stay, postoperative blood transfusion, routine blood analysis, renal function, coagulation function, and inflammatory correlations were secondary outcomes. Propensity score matching (PSM) was performed utilizing logistic regression.

RESULTS

Among the 864 patients identified from the electronic medical record data database, we screened out those with incomplete medical record data. After PSM of the baseline values of the two groups of patients, data of 309 patients (206 patients in spinal anesthesia group and 103 patients in general anesthesia) were utilized in this study. 67/309 patients had complications, including postoperative limb dysfunction, pulmonary infection, delirium, lower extremity venous thrombosis, and shock. The incidence of complications was not related to anesthesia methods (P > 0.05), but the levels of D-Dimer (P = 0.017), fibrinogen (P = 0.005), and high-sensitivity C-reactive protein (hsCRP) (P = 0.002) in the spinal anesthesia group were significantly higher than those in the general anesthesia group.

CONCLUSION

Anesthesia technology is not a risk factor for postoperative complications of hip surgery. The levels of D-Dimer and hsCRP were higher in the spinal anesthesia group.

Keywords: Spinal anesthesia; General anesthesia; Hip surgery; Older population; Complications

Core Tip: This is a retrospective cohort study. We used the propensity score matching to compare the preoperative data of retrospectively selected patients between groups. A total of 309 patients were selected to evaluate whether different anesthesia methods affect the incidence of postoperative complications of hip surgery in elderly patients. The current results showed no difference in postoperative complications between elderly patients undergoing hip surgery under spinal anesthesia and general anesthesia.