Total intravenous anesthesia for geriatric hip fracture with severe systemic disease

Yu Yi Huang, Chung Kun Hui, Ngi Chiong Lau, Yuet Tong Ng, Tung Yi Lin, Chien Hao Chen, Ying Chih Wang, Hao Che Tang, Dave Wei Chih Chen, Chia Wei Chang*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

Abstract

Purpose: Our study aimed to determine the impact of a novel technique of anesthesia administration on the clinical outcomes and complications in geriatric patients with severe systemic disease undergoing hip surgery. Methods: We retrospectively identified patients aged > 65 years with severe systemic disease that was a constant of life [American Society of Anesthesiologists (ASA) IV] who underwent surgery for hip fracture between January 2018 and January 2020. The patients were divided into two groups: Group I [fascia iliaca compartment block plus propofol-based total intravenous anesthesia (FICB + TIVA)] and Group II [general anesthesia (GA)]. The primary outcomes were 30-day and 1-year mortality. The secondary outcomes included length of hospital stay, length of intensive care unit (ICU) stay, postoperative morbidity, Visual Analog Scale score, and consumption of analgesics. Results: There was no significant difference in the 30-day mortality (5 vs. 3.8%, p = 0.85) and 1-year mortality (15 vs. 12%, p = 0.73) between the groups. Group I had significantly lower ICU requirements (p = 0.01) and shorter lengths of ICU stay (p < 0.001) and hospital stay (p < 0.001). Moreover, a smaller proportion of patients in Group I required postoperative morphine or oral opiates. Conclusion: Geriatric patients who underwent hip surgery under FICB + TIVA required fewer ICU admissions, shorter lengths of ICU and hospital stay, and had lesser postoperative opioid consumption than those who were under GA. Hence, we recommend the novel FICB + TIVA technique for hip fracture surgery in geriatric patients with poor general health status and high surgical risks (ASA IV).

Original languageEnglish
Pages (from-to)2139-2145
Number of pages7
JournalEuropean Journal of Trauma and Emergency Surgery
Volume49
Issue number5
DOIs
StatePublished - 10 2023

Bibliographical note

Publisher Copyright:
© 2023, The Author(s).

Keywords

  • Geriatric
  • Hip fracture
  • Nerve block
  • TIVA

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