Comparison of general anaesthesia and regional anaesthesia in terms of mortality and complications in elderly patients with hip fracture: a nationwide population-based study

Objective To evaluate the effects of anaesthesia on postoperative outcome in elderly patients who underwent hip fracture surgery. Setting Nationwide National Health Insurance Sharing Service database of Korea. Participants All patients aged >= 65 years old who underwent hip fracture surgery, covered by the Korean National Health Insurance, between 1 January 2009 and 31 December 2015. Interventions Hip fracture surgery under general anaesthesia (group GA) or regional anaesthesia (group RA), with a principal diagnosis of femoral fracture. Primary and secondary outcome measures The primary outcome was the anaesthetic-type effect on 30-day mortality and the secondary outcome was postoperative delirium requiring pharmacological intervention. Results Among the 96289 patients who underwent hip fracture surgery, 25593 and 70696 patients received GA and RA, respectively. After propensity score matching, 25593 remained in each group. Postmatching mortality was lower in the RA than in the GA group (574 (2.24%) vs 654 (2.55%), p=0.0047, 95% CI -0.0099 to 0.0159). Delirium incidence was lower in the RA than in the GA group (5187 (20.27%) vs 5828 (22.77%), p<0.0001, 95%CI 0.019 to 0.045). The incidence of intensive care unit stay and ventilator care was lower in the RA than in the GA group (5838 (22.1%) vs 8055 (31.47%), p<0.0001, 95%CI 0.046 to 0.070 and 459 (1.73%) vs 1207 (4.72%), p<0.0001, 95%CI -0.0024 to 0.023, respectively). Conclusion RA was associated with better outcomes than GA, in terms of mortality, delirium, intensive care unit admission and ventilator care, in elderly patients who underwent hip fracture surgery.