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Propensity Score-matched Comparison of Postoperative Adverse Outcomes between Geriatric Patients Given a General or a
Chin-Chen Chu1, Shih-Feng Weng, Kuan-Ting Chen
1From the Department of Anesthesiology (C.-C. Chu, K.-T.C., J.-P.S., J.-Y.C., J.-J.W.), Department of Medical Research (S.-F.W., J.-J.W.), and Department of Nephrology (C.-C. Chien), Chi Mei Medical Center, Tainan, Taiwan; Department of Senior Service Management (J.-Y.C.), Department of Hospital and Health Care Administration (S.-F.W.), and Department of Recreation and Health-Care Management (C.-C. Chu), Chia-Nan University of Pharmacy and Science, Tainan, Taiwan; and Department of Medical Laboratory Science and Biotechnology, Chung Hwa University of Medical Technology, Tainan, Taiwan (C.-C. Chien).
Background:
The effects of the mode of anesthesia on major adverse postoperative outcomes in geriatric patients are still inconclusive. The authors hypothesized that a neuraxial anesthetic (NA) rather than a general anesthetic (GA) would yield better in-hospital postoperative outcomes for geriatric patients undergoing hip surgery.
Methods:
The authors used data from Taiwan's 1997-2011 in-patient claims database to evaluate the effect of anesthesia on in-hospital outcomes. The endpoints were mortality, stroke, transient ischemic stroke, myocardial infarction, respiratory failure, and renal failure. Of the 182,307 geriatric patients who had hip surgery, a GA was given to 53,425 (29.30%) and an NA to 128,882 (70.70%). To adjust for baseline differences and selection bias, patients were matched on propensity scores, which left 52,044 GA and 52,044 NA patients.
Results:
GA-group patients had a greater percentage and higher odds of adverse in-hospital outcomes than did NA-group patients: death (2.62 vs. 2.13%; odds ratio [OR], 1.24; 95% CI, 1.15 to 1.35; P < 0.001), stroke (1.61 vs. 1.38%; OR, 1.18, 95% CI, 1.07 to 1.31; P = 0.001), respiratory failure (1.67 vs. 0.63%; OR, 2.71; 95% CI, 2.38 to 3.01; P < 0.001), and intensive care unit admission (11.03 vs. 6.16%; OR, 1.95; 95% CI, 1.87 to 2.05; P < 0.001), analyzed using conditional logistic regression. Moreover, patients given a GA had longer hospital stays (10.77 ± 8.23 vs. 10.44 ± 6.67 days; 95% CI, 0.22 to 0.40; P < 0.001) and higher costs (New Taiwan Dollars [NT$] 86,606 ± NT$74,162 vs. NT$74,494 ± NT$45,264; 95% CI, 11,366 to 12,859; P < 0.001).
Conclusion:
For geriatric patients undergoing hip surgery, NA was associated with fewer odds of adverse outcomes than GA.
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