Propensity Score-matched Comparison of Postoperative Adverse Outcomes between Geriatric Patients Given a General or a Neuraxial Anesthetic for Hip Surgery A Population-based Study

doi:10.1097/ALN.0000000000000695

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Title:	Propensity Score-matched Comparison of Postoperative Adverse Outcomes between Geriatric Patients Given a General or a Neuraxial Anesthetic for Hip Surgery A Population-based Study
Authors:	Chu, Chin-Chen Weng, Shih-Feng Chen, Kuan-Ting Chien, Chih-Chiang Shieh, Ja-Ping Chen, Jen-Yin Wang, Jhi-Joung
Contributors:	老人服務事業管理系醫務管理系休閒保健管理系
Keywords:	Patent foramen ovale Fracture surgery Ischemic-stroke Regional anesthesia Randomized-trials Comorbidity index Spinal-anesthesia Economic burden Metaanalysis Mortality
Date:	2015-07
Issue Date:	2016-04-19 19:03:09 (UTC+8)
Publisher:	Lippincott Williams & Wilkins
Abstract:	Background: The effects of the mode of anesthesia on major adverse postoperative outcomes in geriatric patients are still inconclusive. The authors hypothesized that a neuraxial anesthetic (NA) rather than a general anesthetic (GA) would yield better in-hospital postoperative outcomes for geriatric patients undergoing hip surgery.Methods: The authors used data from Taiwan's 1997-2011 in-patient claims database to evaluate the effect of anesthesia on in-hospital outcomes. The endpoints were mortality, stroke, transient ischemic stroke, myocardial infarction, respiratory failure, and renal failure. Of the 182,307 geriatric patients who had hip surgery, a GA was given to 53,425 (29.30%) and an NA to 128,882 (70.70%). To adjust for baseline differences and selection bias, patients were matched on propensity scores, which left 52,044 GA and 52,044 NA patients.Results: GA-group patients had a greater percentage and higher odds of adverse in-hospital outcomes than did NA-group patients: death (2.62 vs. 2.13%; odds ratio [OR], 1.24; 95% CI, 1.15 to 1.35; P < 0.001), stroke (1.61 vs. 1.38%; OR, 1.18, 95% CI, 1.07 to 1.31; P = 0.001), respiratory failure (1.67 vs. 0.63%; OR, 2.71; 95% CI, 2.38 to 3.01; P < 0.001), and intensive care unit admission (11.03 vs. 6.16%; OR, 1.95; 95% CI, 1.87 to 2.05; P < 0.001), analyzed using conditional logistic regression. Moreover, patients given a GA had longer hospital stays (10.77 8.23 vs. 10.44 +/- 6.67 days; 95% CI, 0.22 to 0.40; P < 0.001) and higher costs (New Taiwan Dollars [NT$] 86,606 +/- NT$74,162 vs. NT$74,494 +/- NT$45,264; 95% CI, 11,366 to 12,859; P < 0.001).Conclusion: For geriatric patients undergoing hip surgery, NA was associated with fewer odds of adverse outcomes than GA.
Relation:	Anesthesiology, v.123 n.1, pp.136-147
Appears in Collections:	[Dept. of Recreation and Health-Care Management] Periodical Articles [Dept. of Hospital and Health (including master's program)] Periodical Articles [Dept. of Senior Service and Health Management] Periodical Articles

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