Comparison of Peripheral Nerve Block and Spinal Anesthesia in Terms of Postoperative Mortality and Walking Ability in Elderly Hip Fracture Patients – A Retrospective, Propensity-Score Matched Study

Abstract

Guangtao Fu,1,* Haotao Li,1,2,* Hao Wang,1 Ruiying Zhang,1 Mengyuan Li,1 Junxing Liao,1 Yuanchen Ma,1 Qiujian Zheng,1 Qingtian Li1 1Department of Orthopedics, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, People’s Republic of China; 2College of Clinical Medicine, Shantou University, Shantou, Guangdong Province, People’s Republic of China*These authors contributed equally to this workCorrespondence: Qingtian LiDepartment of Orthopedics, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, 106, Zhongshan 2nd Road, Yuexiu District, Guangzhou, Guangdong Province, People’s Republic of ChinaTel [phone]Email [email protected]: To compare the effects of peripheral nerve block (PNB) and spinal anesthesia (SA) on one-year mortality and walking ability of elderly hip fracture patients after hip arthroplasty.Methods: Patients ≥ 65 years who underwent unilateral hip arthroplasty due to femoral neck fracture, using either PNB or SA from 2014 to 2019, were included. Demographic data, comorbidities, and results of preoperative screening were retrospectively collected. Propensity score matching (PSM) was performed in a ratio of 1:1 for PNB and SA groups. The primary outcomes were 30-day, 90-day, and one-year mortality. Secondary outcomes included walking ability in the first postoperative year, major complications, length of stay, and the cost of hospitalization. Survival analysis was performed using Kaplan–Meier method.Results: Three hundred and sixteen patients were included, of whom 200 received SA and 116 received PNB. Eighty-nine patients in each group were matched after PSM. Patients in the PNB group showed significantly lower risks of death in 30 days (2.2% vs 10.1%, P=0.029) and 90 days (3.4% vs 12.4%, P=0.026) after hip arthroplasty, when compared to the SA group. There was no significant difference in one-year mortality, walking ability, major complications, and length of stay. Higher hospitalization cost was found in the PNB group (53,828.21 CNY vs 59,278.83 CNY, P=0.024). One-year accumulated survival rate was higher in the PNB group without reaching a significant level.Conclusion: PNB was related to lower 30- and 90-day mortality but higher hospitalization cost in elderly hip fracture patients after hip arthroplasty. However, the anesthesia types were not associated with one-year mortality, one-year walking ability, major complications, and length of stay.Keywords: elderly hip fracture, 30-day mortality, walking ability, peripheral nerve block, propensity score matching

Keywords

• elderly hip fracture
• 30-day mortality
• walking ability
• peripheral nerve block
• propensity score matching.