Temporal Trends in the Use of Regional Anesthesia for Hip Fracture Surgery: A Retrospective Single-Center Study

Hip fractures are associated with significant morbidity and mortality in the United States. Over the past decade, considerable research has been directed toward identifying the optimal anesthetic and analgesic techniques for hip fracture surgery. It was hypothesized that regional anesthesia (neuraxial anesthesia and peripheral nerve blocks) may improve outcomes by avoiding the risks of general anesthesia and providing opioid-sparing analgesia in these complex patients. For neuraxial anesthesia, evidence of clinical benefit has been inconsistent in the literature; however, studies on peripheral nerve block analgesia have shown more consistent advantages. It is unclear if this data has influenced changes in clinical practice.

We conducted a retrospective single-center study of patients who underwent hip fracture surgery at the University of Virginia Medical Center from 2018 to 2022. Descriptive statistics were produced for patient demographics and clinical characteristics, and generalized linear regression models were used to examine trends in anesthetic techniques (general versus neuraxial anesthesia and use of peripheral nerve blocks) over time. We also examined the association between regional anesthesia and patient outcomes, including hospital length of stay (primary outcome), postoperative pain scores, incidence of acute kidney injury and myocardial injury, and discharge disposition (secondary outcomes), as well as diurnal variation in regional anesthesia utilization.

We observed a 30% increase in the number of neuraxial anesthesia cases per year (from 10% (n = 12) of patients in 2018 to 33% (n = 40) in 2022), as well as an increase in peripheral nerve block utilization over time (1.7% (n = 2) of patients in 2018 to 28.1% (n = 34) in 2022). Neuraxial anesthesia was associated with a 17.1% lower hospital length of stay compared to general anesthesia (primary outcome, mean 6.2 vs 7.4 days, p = 0.006). There were no other differences in postoperative outcomes, and there was no evidence of diurnal variation in regional anesthesia utilization.

The increase in peripheral nerve block utilization demonstrates continued progress in quality of care, while emphasizing that there is still significant room for improvement. A larger multicenter database study will be helpful to assess if the evolving literature has influenced broader changes in clinical practice.