[Complications during implantation of 3260 hip endoprostheses under spinal anesthesia]

There is a tendency to perform increasingly severe operations on patients of advanced age. Because geriatric patients are of greater risk when under anesthesia during operation, it is necessary to be aware of the possible anesthesia-related and operation-related complications. In a retrospective study the complication rate with regard to patients (age, multimorbidity), operation (e.g. number and duration of procedures) and anesthesia was analyzed. Of particular interest were the kind and degree of certain complications at a particular time. Directly following the induction of anesthesia and the second application of cement the complication rate depended on patient age and multimorbidity, but the intraoperative complication rate was closely related to the operation. Sensory spreading of spinal anesthesia was one of the anesthesiological factors leading to an increase in the complication rate. Cardiovascular complications occurred most frequently following the induction of spinal anesthesia (hypotension: 6.50%, tachycardias: 3.74%, bradycardias: 3.68%). The most serious circulatory complication--shock--however was primarily seen during surgery [1.80% (n = 59)]. Asystoles [0.27% (n = 9)] were only seen intraoperatively and after the second cement application. Pulmonary embolism [0.12% (n = 4)], respiratory arrest [0.09% (n = 3)] and exitus [0.64% (n = 21)] exclusively occurred following the second administration of cement. Geriatric patients are particularly at risk directly after induction of anesthesia and following application of the second cement. Thorough preoperative preparation (with regard to the cardiac and circulatory situation), spinal anesthesia of less than Th 6 and a rapid surgical procedure are necessary to reduce the morbidity and mortality.