Secondary analysis of outcomes after 11,085 hip fracture operations from the prospective UK Anaesthesia Sprint Audit of Practice (ASAP-2)

White, S.M. and Moppett, I.K. and Griffiths, R. and Johansen, A. and Wakeman, R. and Boulton, C. and Plant, F. and Williams, A. and Pappenheim, K. and Majeed, A. and Currie, C.T. and Grocott, M.P.W. (2016) Secondary analysis of outcomes after 11,085 hip fracture operations from the prospective UK Anaesthesia Sprint Audit of Practice (ASAP-2). Anaesthesia, 71 (5). pp. 506-514. ISSN 0003-2409

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Abstract

We re-analysed prospective data collected by anaesthetists in the Anaesthesia Sprint Audit of Practice (ASAP-1) to describe associations with linked outcome data. Mortality was 165/11,085 (1.5%) 5 days and 563/11,085 (5.1%) 30 days after surgery and was not associated with anaesthetic technique (general vs. spinal, with or without peripheral nerve blockade). The risk of death increased as blood pressure fell: the odds ratio (95% CI) for mortality within five days after surgery was 0.983 (0.973–0.994) for each 5 mmHg intra-operative increment in systolic blood pressure, p = 0.0016, and 0.980 (0.967–0.993) for each mmHg increment in mean pressure, p = 0.0039. The equivalent odds ratios (95% CI) for 30-day mortality were 0.968 (0.951–0.985), p = 0.0003 and 0.976 (0.964–0.988), p = 0.0001, respectively. The lowest systolic blood pressure after intrathecal local anaesthetic relative to before induction was weakly correlated with a higher volume of subarachnoid bupivacaine: r2 −0.10 and −0.16 for hyperbaric and isobaric bupivacaine, respectively. A mean 20% relative fall in systolic blood pressure correlated with an administered volume of 1.44 ml hyperbaric bupivacaine. Future research should focus on refining standardised anaesthesia towards administering lower doses of spinal (and general) anaesthesia and maintaining normotension.

Item Type: Article
Keywords: aging: cardiovascular physiology; lspinal anesthaesia: complications; spinal hypotension: treatment
Schools/Departments: University of Nottingham, UK > Faculty of Medicine and Health Sciences > School of Medicine > Division of Clinical Neuroscience
Identification Number: 10.1111/anae.13415
Depositing User: Eprints, Support
Date Deposited: 12 May 2017 08:58
Last Modified: 13 Oct 2017 00:38
URI: http://eprints.nottingham.ac.uk/id/eprint/42801

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