Comparative outcome of anaesthetic for elderly hip fracture

Current guidelines recommend offering patients both options of a spinal or general anaesthetic. At local level we attempt to ensure whether similar outcome is reflected in our practice regarding difference between General anaesthesia(GA) and Spinal Anaesthesia(SA) in morbidity and mortality.

Data from spreadsheet maintained for NHFD was used to identify patients with Neck of Femur Fracture in 2018.Mortality data was retrieved from the Welsh Clinical Portal. Data was organised according to the type of anaesthetic received. Outcome measures for Morbidity (length of stay in hospital) and Mortality (at both 30 days and 120 days) following surgery, were then inputted for these patients. Statistical analysis was performed using SPSS software. A Mann Whitney U Test was performed for length of stay and Kaplan-Meier Estimates for survival at 30 and 120 days. Log Rank (Mantel Cox) Hypothesis Test is used to compare mortality between two Anaesthetic groups.

We reviewed 203 patients elderly hip fracture with mean age of 83 (range 60-99), there were 142 Female and 61 males.4 patients were treated non operatively, and 2 patients had no data available 0.146 patient received GA and 46 received spinal anaesthesia. Hemiarthroplasty and DHS are commonest procedure in both groups. On applying Mann Whitney U test There is no statistical difference between the length of stay There is no statistical difference between the length of stay for SA and GA Patients. (p = 0.483). for SA and GA Patients (p = 0.483). On APPLYING Log Rank (Mantel-Cox) Analysis there is no statically difference in mortality at 30 days and 120 days with p value 0.087 and 0.397 respectively.

In summary, this audit remains in line with current literature, that there is not a significant difference between the length of stay, survival at 30 days and at 120 days between the two different groups.