The Effect of Anesthetic Type on Outcomes of Hip Fracture Surgery: A Nationwide Population-Based Study

Hip fractures are a global public health problem. During surgery following hip fractures, both general and regional anesthesia are used, but which type of anesthesia offers a better outcome remains controversial. There has been little research evaluating different anesthetic types on mortality and readmission rates for hip fracture surgery using nationwide population-based data. We used nationwide population-based data to examine the effect of anesthetic type on mortality and readmission rates for hip fracture surgery. Retrospective observational study. General acute care hospitals throughout Taiwan. A total of 17,189 patients hospitalized for hip fracture surgery in 2011. Generalized estimating equation models with propensity score weighting were performed after adjustment for patient, surgeon, and hospital characteristics to examine the associations of anesthesia type with 30-day all-cause mortality, 30-day all-cause readmission, and 30-day specific-cause readmission (including surgical site infection, sepsis, acute respiratory failure, acute stroke, acute myocardial infarction, acute renal failure, deep vein thrombosis, pneumonia, and urinary tract infection). Of 17,189 patients, 11,153 (64.9%) received regional anesthesia and 6036 (35.1%) received general anesthesia. Overall, the 30-day mortality rate was 1.7%, and the 30-day readmission rate was 12.3%. Regional anesthesia was not associated with decreased 30-day all-cause mortality (odds ratio [OR] 0.89, 95% confidence interval [CI] 0.67–1.18, P = 0.409), but associated with decreased 30-day all-cause readmission and surgical site infection readmission relative to general anesthesia (OR 0.83, 95% CI 0.75–0.93, P = 0.001 and OR 0.69, 95% CI 0.49–0.97, P = 0.031). Regional anesthesia is not associated with 30-day mortality, but is associated with lower 30-day all-cause and surgical site infection readmission compared with general anesthesia for hip fracture surgery.