Cargando…

Perioperative outcomes in geriatric patients undergoing hip fracture surgery with different anesthesia techniques: A systematic review and meta-analysis

BACKGROUND: Previous meta-analyses assessing anesthetic techniques in adult patients undergoing hip fractures surgery are available. However, whether the anesthetic technique is associated with risk of mortality and complications in geriatric patients with hip fractures remains unclear. This study w...

Descripción completa

Detalles Bibliográficos
Autores principales: Chen, Dong Xu, Yang, Lei, Ding, Lin, Li, Shi Yue, Qi, Ya Na, Li, Qian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6919429/
https://www.ncbi.nlm.nih.gov/pubmed/31804347
http://dx.doi.org/10.1097/MD.0000000000018220
_version_ 1783480756401602560
author Chen, Dong Xu
Yang, Lei
Ding, Lin
Li, Shi Yue
Qi, Ya Na
Li, Qian
author_facet Chen, Dong Xu
Yang, Lei
Ding, Lin
Li, Shi Yue
Qi, Ya Na
Li, Qian
author_sort Chen, Dong Xu
collection PubMed
description BACKGROUND: Previous meta-analyses assessing anesthetic techniques in adult patients undergoing hip fractures surgery are available. However, whether the anesthetic technique is associated with risk of mortality and complications in geriatric patients with hip fractures remains unclear. This study was conducted to assess postoperative outcomes of anesthesia technique in geriatric patients undergoing hip fracture surgery. METHODS: Cochrane Library, PubMed, EMBASE, MEDLINE, CNKI, and CBM were searched from inception up to May 25, 2018. Observational studies and randomized controlled trials (RCTs) that assessed the perioperative outcomes of technique of anesthesia (general or regional [epidural/spinal/neuraxial]) in geriatric patients (≥60 years old) undergoing hip fracture surgery were included. Two investigators independently screened studies for inclusion and performed data extraction. Heterogeneity was assessed by the I(2) and Chi-square tests. The odds ratio (OR) of the dichotomous data, mean difference (MD) of continuous data, and 95% confidence intervals (CI) were calculated to assess the pooled data. RESULTS: Eleven retrospective and 2 RCTs were included. There was no difference in 30-day mortality (OR = 0.96; 95% CI 0.86–1.08; P = .51) between the general and regional anesthesia groups. In-hospital mortality (OR = 1.26; 95% CI 1.17–1.36; P < .001), acute respiratory failure (OR = 2.66; 95% CI 2.34–3.02; P < .001), length of hospital stay (MD = 0.33; 95% CI 0.24–0.42; P < .001), and readmission (OR = 1.09; 95% CI 1.01–1.18; P = .03) were significantly reduced in the regional anesthesia group. Pneumonia (OR = 0.99; 95% CI 0.91–1.07; P = .79), heart failure (OR = 0.97; 95% CI 0.86–1.09; P = .62), acute myocardial infraction (OR = 1.07; 95% CI 0.99–1.16; P = .10), acute renal failure (OR = 1.32; 95% CI 0.97–1.79; P = .07), cerebrovascular accident (OR = 1.08; 95% CI 0.82–1.42; P = .58), postoperative delirium (OR = 1.51; 95% CI 0.16–13.97; P = .72), and deep vein thrombosis/pulmonary embolism (OR = 1.42; 95% CI 0.84–2.38; P = .19) were similar between the two anesthetic techniques. CONCLUSION: General anesthesia is associated with increased risk of in-hospital mortality, acute respiratory failure, longer hospital stays, and higher readmission. There is evidence to suggest that regional anesthesia is associated with improved perioperative outcomes. Large RCTs are needed to explore the most optimal anesthetic techniques for geriatric patients with hip fractures before drawing final conclusions. PROSPERO REGISTRATION NUMBER: CRD42018093582.
format Online
Article
Text
id pubmed-6919429
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher Wolters Kluwer Health
record_format MEDLINE/PubMed
spelling pubmed-69194292020-01-23 Perioperative outcomes in geriatric patients undergoing hip fracture surgery with different anesthesia techniques: A systematic review and meta-analysis Chen, Dong Xu Yang, Lei Ding, Lin Li, Shi Yue Qi, Ya Na Li, Qian Medicine (Baltimore) 3700 BACKGROUND: Previous meta-analyses assessing anesthetic techniques in adult patients undergoing hip fractures surgery are available. However, whether the anesthetic technique is associated with risk of mortality and complications in geriatric patients with hip fractures remains unclear. This study was conducted to assess postoperative outcomes of anesthesia technique in geriatric patients undergoing hip fracture surgery. METHODS: Cochrane Library, PubMed, EMBASE, MEDLINE, CNKI, and CBM were searched from inception up to May 25, 2018. Observational studies and randomized controlled trials (RCTs) that assessed the perioperative outcomes of technique of anesthesia (general or regional [epidural/spinal/neuraxial]) in geriatric patients (≥60 years old) undergoing hip fracture surgery were included. Two investigators independently screened studies for inclusion and performed data extraction. Heterogeneity was assessed by the I(2) and Chi-square tests. The odds ratio (OR) of the dichotomous data, mean difference (MD) of continuous data, and 95% confidence intervals (CI) were calculated to assess the pooled data. RESULTS: Eleven retrospective and 2 RCTs were included. There was no difference in 30-day mortality (OR = 0.96; 95% CI 0.86–1.08; P = .51) between the general and regional anesthesia groups. In-hospital mortality (OR = 1.26; 95% CI 1.17–1.36; P < .001), acute respiratory failure (OR = 2.66; 95% CI 2.34–3.02; P < .001), length of hospital stay (MD = 0.33; 95% CI 0.24–0.42; P < .001), and readmission (OR = 1.09; 95% CI 1.01–1.18; P = .03) were significantly reduced in the regional anesthesia group. Pneumonia (OR = 0.99; 95% CI 0.91–1.07; P = .79), heart failure (OR = 0.97; 95% CI 0.86–1.09; P = .62), acute myocardial infraction (OR = 1.07; 95% CI 0.99–1.16; P = .10), acute renal failure (OR = 1.32; 95% CI 0.97–1.79; P = .07), cerebrovascular accident (OR = 1.08; 95% CI 0.82–1.42; P = .58), postoperative delirium (OR = 1.51; 95% CI 0.16–13.97; P = .72), and deep vein thrombosis/pulmonary embolism (OR = 1.42; 95% CI 0.84–2.38; P = .19) were similar between the two anesthetic techniques. CONCLUSION: General anesthesia is associated with increased risk of in-hospital mortality, acute respiratory failure, longer hospital stays, and higher readmission. There is evidence to suggest that regional anesthesia is associated with improved perioperative outcomes. Large RCTs are needed to explore the most optimal anesthetic techniques for geriatric patients with hip fractures before drawing final conclusions. PROSPERO REGISTRATION NUMBER: CRD42018093582. Wolters Kluwer Health 2019-12-10 /pmc/articles/PMC6919429/ /pubmed/31804347 http://dx.doi.org/10.1097/MD.0000000000018220 Text en Copyright © 2019 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by/4.0 This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0
spellingShingle 3700
Chen, Dong Xu
Yang, Lei
Ding, Lin
Li, Shi Yue
Qi, Ya Na
Li, Qian
Perioperative outcomes in geriatric patients undergoing hip fracture surgery with different anesthesia techniques: A systematic review and meta-analysis
title Perioperative outcomes in geriatric patients undergoing hip fracture surgery with different anesthesia techniques: A systematic review and meta-analysis
title_full Perioperative outcomes in geriatric patients undergoing hip fracture surgery with different anesthesia techniques: A systematic review and meta-analysis
title_fullStr Perioperative outcomes in geriatric patients undergoing hip fracture surgery with different anesthesia techniques: A systematic review and meta-analysis
title_full_unstemmed Perioperative outcomes in geriatric patients undergoing hip fracture surgery with different anesthesia techniques: A systematic review and meta-analysis
title_short Perioperative outcomes in geriatric patients undergoing hip fracture surgery with different anesthesia techniques: A systematic review and meta-analysis
title_sort perioperative outcomes in geriatric patients undergoing hip fracture surgery with different anesthesia techniques: a systematic review and meta-analysis
topic 3700
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6919429/
https://www.ncbi.nlm.nih.gov/pubmed/31804347
http://dx.doi.org/10.1097/MD.0000000000018220
work_keys_str_mv AT chendongxu perioperativeoutcomesingeriatricpatientsundergoinghipfracturesurgerywithdifferentanesthesiatechniquesasystematicreviewandmetaanalysis
AT yanglei perioperativeoutcomesingeriatricpatientsundergoinghipfracturesurgerywithdifferentanesthesiatechniquesasystematicreviewandmetaanalysis
AT dinglin perioperativeoutcomesingeriatricpatientsundergoinghipfracturesurgerywithdifferentanesthesiatechniquesasystematicreviewandmetaanalysis
AT lishiyue perioperativeoutcomesingeriatricpatientsundergoinghipfracturesurgerywithdifferentanesthesiatechniquesasystematicreviewandmetaanalysis
AT qiyana perioperativeoutcomesingeriatricpatientsundergoinghipfracturesurgerywithdifferentanesthesiatechniquesasystematicreviewandmetaanalysis
AT liqian perioperativeoutcomesingeriatricpatientsundergoinghipfracturesurgerywithdifferentanesthesiatechniquesasystematicreviewandmetaanalysis