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Effect of anesthesia technique on outcome after hip fracture surgery in elderly adult patients : A randomized, controlled trial
Session: EX-09
Fri, April 20, 7:40-7:50 am
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Hip fractures are associated with a substantial risk of morbidity and mortality in geriatric patients.1,2

Several biomarkers such as troponin-T and interleukin-6 (IL-6) have been implicated in predicting short-term and long-term mortality in patients with hip fracture.2 A previous study revealed that high mobility group box-1 (HMGB-1) was associated with prognosis in patients with multiple traumas, but the association with prognosis in simple fractures such as a hip fracture remains unknown.3

Several investigations have attempted to determine the effect of anesthetic type on mortality and morbidity after hip fracture surgery, but most recent meta-analyses of randomized clinical studies have produced mixed results and have been unable to conclude that anesthetic type influences mortality.4



In this randomized controlled study, we evaluated the degree of inflammation according to the choice of anesthetic method through biomarker (HMGB-1 and IL-6) and their roles as prognostic factors.
We also observed whether there were any differences in the postoperative mortality rate and hospital stay according to anesthetic technique.
<Materials & Methods>

After obtaining institutional review board approval and written informed patient consent, patients who were 65 years or older and who had planned or emergency hip fracture surgery were randomly divided into three groups according to anesthetic type.

Group D: Desflurane anesthesia, Group P: Propofol anesthesia, Group S: Spinal anesthesia

The primary outcomes were HMGB-1 and IL-6, which were measured before surgery, on the first day and second day after surgery.

Additionally, N-terminal prohormone of brain natriuretic peptide (NT-proBNP), albumin, troponin-T, and C-reactive protein (CRP) were measured.

The secondary outcomes were 30-day and one-year mortality and the postoperative length of hospital stay.


<Results & Discussion>

Total 130 patients were enrolled and randomized into three groups (Group D=43, Group P=47, Group S=40) between May 2015 and November 2017.

The groups had similar demographics and medical comorbidities.

HMBG-1 and IL-6 values were not significantly different between groups. Additionally, other biomarkers such as NT-proBNP, troponin-T, albumin, and CRP showed no differences between the groups (Table 1, Graph 1, 2).

There were no significant differences between groups for 30-day mortality (7% vs.2.1% vs.0%, p=0.207), one-year mortality (7% vs.10.6% vs.10%, p=0.865) and postoperative hospital stay (4 vs.3 vs.4, p=0.555). (Table 2)



In this randomized controlled study, there were no significant differences in biomarkers such as HMGB-1 and IL-6 by anesthesia type among patients undergoing hip fracture surgery.

Additionally, short-term and long-term mortality and postoperative length of hospital stay did not differ significantly among the three groups.



1.Hu F, Jiang C, Shen J, Tang P, Wang Y. Preoperative predictors for mortality following hip fracture surgery: a systematic review and meta-analysis. Injury, 2012. 43(6): 676-85.
2.Neuman MD, Rosenbaum PR, Ludwig JM, Zubizarreta JR, Silber JH. Anesthesia technique, mortality, and length of stay after hip fracture surgery. JAMA, 2014. 311(24): 2508-17.
3.Laulund AS, Lauritzen JB, Duus BR, Mosfeldt M, Jorgensen HL. Routine blood tests as predictors of mortality in hip fracture patients. Injury, 2012. 43(7): 1014-20.
4.Giannoudis PV, Mallina R, Harwood P, Perry S, Sante ED, Pape HC. Pattern of release and relationship between HMGB-1 and IL-6 following blunt trauma. Injury, 2010. 41(12): 1323-7.
5.Patorno E, Neuman MD, Schneeweiss S, Mogun H, Bateman BT. Comparative safety of anesthetic type for hip fracture surgery in adults: retrospective cohort study. BMJ, 2014. 348: g4022.
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