The Association between Anesthesia Techniques and Unplanned Hospital Readmissions in Femur Fracture Repair in the US between 2016 and 2020
Abstract
Introduction and Objective. Hip fracture repair is a common procedure with a worldwide projected rise in the incidence of hip fractures from 1.66 million in 1990 to 6.26 million by 2050, anticipating high hospital readmission and mortality rates. Positive associations have been found between intensive anesthesia and mortality rates compared to mild anesthesia practices. However, there is little research examining hospital readmission across various anesthetic techniques used for hip fracture repairs. The main objective of this study was to determine if there is an association between readmission incidence and anesthesia technique in patients receiving operative femur fracture repair. Methods. This analytical, non-concurrent cohort study used data from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) from 2016 through 2020. The current study included patients aged 65 and older undergoing operational femur fracture repair. Patients with missing information on the main variables were excluded from the analysis. The main outcome included hospital readmission within a 30-day postoperative period. The main exposure was anesthetic techniques, including general and neuraxial anesthesia (spinal and epidural). Covariates considered included assigned ASA classification, age, race, gender, smoking status, and comorbidities (diabetes, heart failure, and dialysis). Unadjusted and adjusted logistic regression analyses were performed to calculate odds ratios (OR) and 95% confidence intervals (CI). Results. The total sample population included 102,193 patients. Readmitted patients that received general anesthesia were 8.5% (n=6,145) while 6.6% (n=1,481) received neuraxial anesthesia. Our data revealed that there was no statistically significant association between general and neuraxial anesthetic techniques and readmission rates for femur fracture operations [0.95; 95% CI 0.88-1.02]. Readmissions were more likely in patients aged 75 and older [OR=1.19; 95% CI 1.11-1.27], insulin users [OR= 1.34 CI 95% 1.23-1.46], patients with CHF [OR=1.44; 95% 1.29-1.61] and those currently on dialysis [OR=1.34; 95% CI 1.15-1.57] when adjusted for covariates. Conclusions-Implications. Using neuraxial anesthesia should not be favored over general sedation in patients receiving hip fracture surgery. Further research should evaluate the association between preoperative and postoperative analgesic medications and the readmission incidence with different anesthetic techniques. Additionally, how intraoperative anesthetics interact with glucose tolerance in diabetic insulin users remains unclear.
Keywords
Anesthesia, Hip Fracture Repair, Readmission
Presentation Type
Poster Presentation
The Association between Anesthesia Techniques and Unplanned Hospital Readmissions in Femur Fracture Repair in the US between 2016 and 2020
Introduction and Objective. Hip fracture repair is a common procedure with a worldwide projected rise in the incidence of hip fractures from 1.66 million in 1990 to 6.26 million by 2050, anticipating high hospital readmission and mortality rates. Positive associations have been found between intensive anesthesia and mortality rates compared to mild anesthesia practices. However, there is little research examining hospital readmission across various anesthetic techniques used for hip fracture repairs. The main objective of this study was to determine if there is an association between readmission incidence and anesthesia technique in patients receiving operative femur fracture repair. Methods. This analytical, non-concurrent cohort study used data from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) from 2016 through 2020. The current study included patients aged 65 and older undergoing operational femur fracture repair. Patients with missing information on the main variables were excluded from the analysis. The main outcome included hospital readmission within a 30-day postoperative period. The main exposure was anesthetic techniques, including general and neuraxial anesthesia (spinal and epidural). Covariates considered included assigned ASA classification, age, race, gender, smoking status, and comorbidities (diabetes, heart failure, and dialysis). Unadjusted and adjusted logistic regression analyses were performed to calculate odds ratios (OR) and 95% confidence intervals (CI). Results. The total sample population included 102,193 patients. Readmitted patients that received general anesthesia were 8.5% (n=6,145) while 6.6% (n=1,481) received neuraxial anesthesia. Our data revealed that there was no statistically significant association between general and neuraxial anesthetic techniques and readmission rates for femur fracture operations [0.95; 95% CI 0.88-1.02]. Readmissions were more likely in patients aged 75 and older [OR=1.19; 95% CI 1.11-1.27], insulin users [OR= 1.34 CI 95% 1.23-1.46], patients with CHF [OR=1.44; 95% 1.29-1.61] and those currently on dialysis [OR=1.34; 95% CI 1.15-1.57] when adjusted for covariates. Conclusions-Implications. Using neuraxial anesthesia should not be favored over general sedation in patients receiving hip fracture surgery. Further research should evaluate the association between preoperative and postoperative analgesic medications and the readmission incidence with different anesthetic techniques. Additionally, how intraoperative anesthetics interact with glucose tolerance in diabetic insulin users remains unclear.