Anesthetic Management of Elderly Patients Undergoing Total Hip Arthroplasty for Femoral Neck Fractures: A...

Introduction Total hip arthroplasty (THA) for femoral neck fractures in elderly patients presents challenges for both surgeons and anesthesiologists. This study aimed to describe anesthesia-related issues and analyze risk factors for morbidity and mortality. Materials and methods This retrospective study was conducted over a four-year period in the Department of Anesthesiology, Mohammed V Military Teaching Hospital in Rabat, Morocco. It included patients aged ≥50 years who underwent surgery for femoral neck fractures and received THA. Results Seventy-nine patients were included, with a mean age of 66.8 ± 10.1 years; 81% were between 50 and 75 years old. Domestic accidents accounted for 62% of fractures. General anesthesia (GA) was administered to 55 patients (69.6%), while 30.4% received spinal anesthesia. Postoperative complications were primarily pain, anemia, and cognitive disorders. Mortality rates at 30 days, three months, and one year were 1.2% (1/79), 6.3% (5/79), and 15.2% (12/79), respectively. Increased mortality risk was associated with type 1 diabetes, anticoagulant use, intraoperative hypotension, perioperative blood transfusion, and longer hospitalization. Spinal anesthesia was associated with a reduced risk of intraoperative hypotension (p = 0.017) but a higher incidence of chronic pain compared with GA (33.3% vs. 12.7%, p = 0.032). Conclusions Outcomes in elderly patients undergoing THA for femoral neck fractures are influenced by comorbidities, prior treatments, and the perioperative course. The choice of anesthetic technique and timing of surgery appear to have a limited impact on prognosis.