The choice of the method of anesthesia as a risk factor in the femoral fracture near the hip joint in elderly patients
Miller, K.; Reichel, M.; Karlbauer, R.; Pauser, G.
Der Anaesthesist 39(2): 83-87
1990
ISSN/ISBN: 0003-2417 PMID: 2310007 Document Number: 347531
Between January 1983 and December 1988, 317 patients with fractures near the hip joint were operated upon. In a retrospective study we compared 180 patients with general anesthesia (AN) and 137 patients with spinal anesthesia (RA). The average age of patients with RA was 80.5 and with AN 79.8 years. The preoperative management was done by an internist. The operation followed at an average of 2.8 days (Tables 1, 2). All patients were placed into 3 risk groups, based on after preoperative cardiac and pulmonary risk scores, as modified by Goldman (Table 3). Spinal anesthesia was performed with 2 ml 4% hyperbaric mepivacaine (80 mg mepivacaine hydrochloride, 190 mg glucose monohydrate). The AN was induced with thiopental (3-5 mg/kg) and maintained with N2O and enflurane. Fentanyl (0.05-0.15 mg) was given for analgesia. The statistical examination was done using the chi-square test (Fisher-exact or Pearson). The groups were compared for age, time of operation, and risk score (Table 4). The mortality in operations with protection of the femoral head (FP) (Ender pinnings, Böhler pinnings and dynamic hip screws) was significantly higher after RA (13.8%), than with AN (6.5%). In operations with hip prostheses (HP), the mortality for RA (19.0%) was also significantly higher then for AN (4.2%) (Fig. 1). The mortality in group I (4-20 points) was 1.7% in patients with AN (FP 1.4%, HP 2.1%) and 3.7% for RA (FP 4.1%, HP 0%).