Newly Published
Perioperative Medicine  |   October 2017
Association of Hospital-level Neuraxial Anesthesia Use for Hip Fracture Surgery with Outcomes: A Population-based Cohort Study
Author Notes
  • From the Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada (D.I.M., G.L.B.); Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.I.M.); Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (D.I.M., C.v.W.); University of Toronto, Toronto, Ontario, Canada (D.N.W.); Geriatric Medicine, Ottawa Hospital, Ottawa, Ontario, Canada (A.H.).
  • Submitted for publication January 4, 2017. Accepted for publication August 31, 2017.
    Submitted for publication January 4, 2017. Accepted for publication August 31, 2017.×
  • Research Support: Supported by a Canadian Anesthesiologists’ Society Dr. R. A. Gordon Research Award for Innovation in Patient Safety, Department of Anesthesiology and Pain Medicine, The University of Ottawa; salary support from the Ottawa Hospital Department of Anesthesiology and the Canadian Anesthesiology Society’s Career Scientist Award (to Dr. McIsaac); and the Institute for Clinical Evaluative Sciences, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC).
    Research Support: Supported by a Canadian Anesthesiologists’ Society Dr. R. A. Gordon Research Award for Innovation in Patient Safety, Department of Anesthesiology and Pain Medicine, The University of Ottawa; salary support from the Ottawa Hospital Department of Anesthesiology and the Canadian Anesthesiology Society’s Career Scientist Award (to Dr. McIsaac); and the Institute for Clinical Evaluative Sciences, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC).×
  • Competing Interests: The opinions, results, and conclusions reported in this article are those of the authors and are independent from the funding sources. No endorsement by Institute for Clinical Evaluative Sciences or the Ontario Ministry of Health and Long-Term Care is intended or should be inferred. These data sets were held securely in a linked, deidentified form and analyzed at the Institute for Clinical Evaluative Sciences.
    Competing Interests: The opinions, results, and conclusions reported in this article are those of the authors and are independent from the funding sources. No endorsement by Institute for Clinical Evaluative Sciences or the Ontario Ministry of Health and Long-Term Care is intended or should be inferred. These data sets were held securely in a linked, deidentified form and analyzed at the Institute for Clinical Evaluative Sciences.×
  • Correspondence: Address correspondence to Dr. McIsaac: Ottawa Hospital, 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9, Canada. dmcisaac@toh.ca. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Regional Anesthesia / Trauma / Burn Care
Perioperative Medicine   |   October 2017
Association of Hospital-level Neuraxial Anesthesia Use for Hip Fracture Surgery with Outcomes: A Population-based Cohort Study
Anesthesiology Newly Published on October 5, 2017. doi:10.1097/ALN.0000000000001899
Anesthesiology Newly Published on October 5, 2017. doi:10.1097/ALN.0000000000001899
Abstract

Background: There is consistent and significant variation in neuraxial anesthesia use for hip fracture surgery across jurisdictions. We measured the association of hospital-level utilization of neuraxial anesthesia, independent of patient-level use, with 30-day survival (primary outcome) and length of stay and costs (secondary outcomes).

Methods: We conducted a population-based cohort study using linked administrative data in Ontario, Canada. We identified all hip fracture patients more than 65 yr of age from 2002 to 2014. For each patient, we measured the proportion of hip fracture patients at their hospital who received neuraxial anesthesia in the year before their surgery. Multilevel, multivariable regression was used to measure the association of log-transformed hospital-level neuraxial anesthetic-use proportion with outcomes, controlling for patient-level anesthesia type and confounders.

Results: Of 107,317 patients, 57,080 (53.2%) had a neuraxial anesthetic; utilization varied from 0 to 100% between hospitals. In total, 9,122 (8.5%) of patients died within 30 days of surgery. Survival independently improved as hospital-level neuraxial use increased (P = 0.009). Primary and sensitivity analyses demonstrated that most of the survival benefit was realized with increase in hospital-level neuraxial use above 20 to 25%; there did not appear to be a substantial increase in survival above this point. No significant associations between hospital neuraxial anesthesia-use and other outcomes existed.

Conclusions: Hip fracture surgery patients at hospitals that use more than 20 to 25% neuraxial anesthesia have improved survival independent of patient-level anesthesia type and other confounders. The underlying causal mechanism for this association requires a prospective study to guide improvements in perioperative care and outcomes of hip fracture patients.