THIRTY DAYS MORTALITY FOLLOWING HIP FRACTURE SURGERY – INFLUENCE OF DURATION OF ANAESTHESIA & DURATION OF SURGERY

Hip fracture is associated with highest mortality following trauma in the elderly. The objective of this study is to evaluate the association between duration of anaesthesia and duration of surgery with 30 days mortality following hip fracture surgery. This retrospective cohort study reviewed patients underwent surgery following hip fracture in a district general hospital. Patients less than 65 years, periprosthetic and pathological fractures were excluded. Totally 254 patients were included in the study, who had surgery between February 2005 and September 2008 (20 months period). Mortality details retrieved through National Statistics database. Chi Square tests and Logistic regression analyses were performed to check the relationship between 30 days mortality and all independent variables including duration of anaesthesia and duration of surgery. The incidence of 30 days mortality following hip fracture surgery was 9.4%. The commonest reason of death was cardiac failure and chest infection. Patients who had General anesthesia (GA) had more complications and mortality in comparison with those who had regional anaesthesia. GA increases the odds of 30 days mortality to 2.5 times. Patients under American Society of Anesthesiologists (ASA) II had decreased odds of 30 days mortality than ASA III & IV (odds Ratio 0.16). However duration of anesthesia up to 120 minutes and duration of surgery up to 90 minutes were not associated with 30 days mortality (P>0.05). The 30 days mortality following dynamic hip screw fixation surgery was 14.6% and intra medullary nail was 12.5%. The 30 days mortality in cemented hemi-arthroplasty was 6.9% and uncemented hemi-arthroplasty was 6%. The 30 days mortality was nil in the group of patients who had undergone cannulated hip screw fixation. In elderly people following hip fracture surgery 30 days mortality was not affected by duration of anaesthesia and duration of surgery. However 30 days mortality was related with GA, ASA III & IV and post-operative complications mainly cardiac failure and chest infection. These patients need specialist medical care