GENERAL VERSUS SPINAL ANESTHESIA: WHICH IS A RISK FACTOR FOR OCTOGENARIAN HIP FRACTURE REPAIR PATIENTS?

Background: Most studies have shown no difference between the two types of anesthesia administered to hip fracture patients. This study compared postoperative morbidity and mortality in octogenarian patients who received either general or spinal anesthesia for hip fracture repair. Methods: We retrospectively analyzed the hospital records of 335 octogenarian patients who received hip fracture repair in our teaching hospital between 2002 and 2006. A total of 167 and 168 patients received general and spinal anesthesia, respectively. Morbidity, mortality, and intraoperative and preoperative variables were compared between groups. Results: There were no mortality differences between spinal and general anesthesia groups. However, the overall morbidity was greater in the general anesthesia group than in the spinal anesthesia group (21/167 [12.6%] vs. 9/168 [5.4%]; p=0.02). Respiratory system-related morbidity was also higher in the general anesthesia group than in the spinal anesthesia group (11/167 [6.6%] vs. 3/168 [1.8%]; p=0.03). Logistic regression analysis revealed two significant predictors of postoperative morbidity: anesthesia type (general; odds ratio, 2.39) and preexisting respiratory diseases (odds ratio, 3.38). Conclusion: General anesthesia increased the risk of postoperative morbidity in octogenarian patients after hip fracture repair, and patients with preexisting respiratory diseases were especially vulnerable. Spinal anesthesia is strongly recommended in such individuals. [International Journal of Gerontology 2010; 4(1): 37-42]