Outcomes and cost-effectiveness of different anesthesia techniques in elderly patients with hip fracture

Abstract

Aim: This study aimed to determine the optimal type of anesthesia for elderly patients to reduce the need for intensive care, mortality, and costs of operations for hip fractures. Material and Methods: In this retrospective and cross-sectional study, the records of 204 patients aged 60 years and older who were operated on for hip fracture with neuraxial (107 patients) or general anesthesia (97 patients) at Pamukkale University Hospital. The duration of intensive care stay, duration of hospital stay, mortality, and cost were considered primary endpoints. Results: All evaluation parameters were evenly distributed between both groups. Among the analyzed parameters, the duration of surgery and the rate of patients requiring >1 unit of blood transfusion were found to be significantly lower in neuraxial anesthesia patients, compared to general anesthesia patients (p=0,001). Intensive care need, duration of intensive care stay and duration of hospital stay, three-month mortality, and cost were found to be significantly lower in the neuraxial anesthesia group, compared to the general anesthesia group (for all p=0.001). Based on logistic regression analysis, age (age 80-89, OR= 2.782, 95% CI= 1.156-6.694; age 90 +, OR= 8.779, CI= 2.056-37.486), general anesthesia (OR = 8.069, 95% CI= 2.778-23.436) and need of intensive care (OR= 5.155, 95% CI= 2.233-11.903) were independent risk factors affecting mortality. Discussion: The results of our study show that the use of neuraxial anesthesia in geriatric hip fracture surgery has significant advantages, including lower costs and mortality rates compared to general anesthesia.