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Regional Anesthesia for Hip Fracture Surgery in Older Adults: A Retrospective Comparison of Outcomes Using ACS NSQIP

Arissa M Torrie^1,2, Gerard P Slobogean¹, Rachel Johnson^1,2

¹Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA.

Geriatric Orthopaedic Surgery & Rehabilitation

|June 30, 2025

Abstract

Introduction:

Surgical fixation of hip fractures in older adults is associated with significant morbidity and mortality. We investigated whether regional anesthesia, which excluded epidural, spinal, or combined epidural-spinal, was associated with lower postoperative complication rates compared to general or spinal anesthesia in patients aged 50 years and older undergoing hip fracture surgery.

Methods:

A retrospective analysis was conducted using the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) Targeted Hip Fracture dataset from January 1, 2016, to December 31, 2022. Propensity score matching was used to compare regional anesthesia with general and spinal anesthesia. Given the NSQIP database excludes epidural, spinal, and combined epidural-spinal anesthesia from the regional classification, it was presumed that the remaining regional anesthesia patients received a peripheral nerve block. The primary outcome measure was a 30-day composite of death, myocardial infarction, or stroke.

Results:

The study analyzed 54,623 patients, from which 323 received regional anesthesia. These were separately matched with 323 cases of general anesthesia and 323 cases of spinal anesthesia. Regional anesthesia was associated with a lower incidence of the primary composite outcome compared to both general anesthesia (3% vs 7%, risk ratio 0.3, 95% CI: 0.2 to 0.6, P < 0.001) and spinal anesthesia (3% vs 7%, risk ratio 0.5, 95% CI: 0.3 to 0.9, P = 0.01). A subgroup effect was detected, with high-risk patients (ASA IV-V) experiencing the greatest protective benefit from regional anesthesia.

Conclusions:

Regional anesthesia techniques, excluding epidural, spinal, or combined epidural-spinal techniques, were associated with lower rates of major postoperative complications in older adults undergoing hip fracture surgery compared to general or spinal anesthesia. This benefit was more pronounced in high-risk patients. Our findings suggest that regional anesthesia, most likely administered via a peripheral nerve block, may offer benefits beyond pain control in this population, potentially improving postoperative outcomes.

Keywords:

general anesthesia hip fractures peripheral nerve blocks postoperative regional anesthesia spinal anesthesia

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