{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T01:00:37Z","timestamp":1792890037465,"version":"4.5.0"},"reference-count":22,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2024,9,4]],"date-time":"2024-09-04T00:00:00Z","timestamp":1725408000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: The incidence of proximal femoral fractures (PFFs) is rising, causing significant morbidity and mortality. Regional anesthesia (RA)\u2019s benefits include the avoidance of intubation and mechanical ventilation, decreased blood loss, and improved analgesia. General anesthesia (GA) offers improved hemodynamic stability. This study examines the in-hospital post-surgical morbidity and mortality seen in PFFs in a cohort of the elderly undergoing GA or RA. Materials and Methods: This is a retrospective cohort study of 319 PFF patients older than 65 years over a single year. Results: In total, 73.7% of patients underwent GA. The patient characteristics were identical between groups, except for smoking. Hypertension was the most frequent comorbidity, followed by hyperlipidemia, NIDDM, and IHD. The overall patient complication rate was 11.4%. Pneumonia was the most common complication (5.1% in GA, 8.4% in RA). A total of 0.9% of patients required ICU admission. Overall, the in-hospital mortality rate was 2.3%, with no statistically significant difference between GA and RA. The GA and RA cohorts were similar in terms of their patient demographics, medical history, and preoperative parameters. In total, 73% of surgeries were under GA. No statistically significant differences were found in total anesthesia time or complication rates. Conclusions: We did not find a difference between general and spinal anesthesia regarding complication rates, anesthesia time, or morbidity. General anesthesia remains best suited for patients receiving anticoagulation treatment and undergoing semi-urgent surgery, but, other than that, the mode of anesthesia administered remains up to the anesthesiologist\u2019s preference.<\/jats:p>","DOI":"10.3390\/medicina60091446","type":"journal-article","created":{"date-parts":[[2024,9,4]],"date-time":"2024-09-04T04:28:28Z","timestamp":1725424108000},"page":"1446","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Anesthesia\u2019s Influence on Postoperative In-Hospital Morbidity\u2013Mortality in Proximal Femoral Fractures in the Elderly"],"prefix":"10.3390","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2975-9152","authenticated-orcid":false,"given":"Oded","family":"Hershkovich","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Wolfson Medical Center, Affiliated to the Sackler School of Medicine, Holon 5822012, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inga","family":"Tetroashvili","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Wolfson Medical Center, Affiliated to the Sackler School of Medicine, Holon 5822012, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam Lee","family":"Goldstein","sequence":"additional","affiliation":[{"name":"Trauma Unit, Wolfson Medical Center, Affiliated to the Sackler School of Medicine, Holon 5822012, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7968-7906","authenticated-orcid":false,"given":"Raphael","family":"Lotan","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Wolfson Medical Center, Affiliated to the Sackler School of Medicine, Holon 5822012, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,9,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1573","DOI":"10.1001\/jama.2009.1462","article-title":"Incidence and mortality of hip fractures in the United States","volume":"302","author":"Brauer","year":"2009","journal-title":"JAMA"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1186\/s13584-018-0235-y","article-title":"The epidemiology and economic burden of hip fractures in Israel","volume":"7","author":"Barnea","year":"2018","journal-title":"Isr. J. Health Policy Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1016\/S8756-3282(01)00614-7","article-title":"Epidemiology of fractures in England and Wales","volume":"29","author":"Dennison","year":"2001","journal-title":"Bone"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1097\/MLR.0b013e3181ca4126","article-title":"Non-operative care for hip fracture in the elderly: The influence of race, income, and comorbidities","volume":"48","author":"Neuman","year":"2010","journal-title":"Med. Care"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1374","DOI":"10.1136\/bmj.38643.663843.55","article-title":"Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: Prospective observational cohort study","volume":"331","author":"Roche","year":"2005","journal-title":"BMJ"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2053","DOI":"10.1001\/archinte.162.18.2053","article-title":"Medical complications and outcomes after hip fracture repair","volume":"162","author":"Lawrence","year":"2002","journal-title":"Arch. Intern. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"34","DOI":"10.2106\/JBJS.G.00065","article-title":"Patient risk factors, operative care, and outcomes among older community-dwelling male veterans with hip fracture","volume":"90","author":"Radcliff","year":"2008","journal-title":"J. Bone Jt. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1136\/bmj.333.7557.27","article-title":"Hip fracture","volume":"333","author":"Parker","year":"2006","journal-title":"BMJ"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.1111\/j.1525-1497.2005.00219.x","article-title":"Best practices for elderly hip fracture patients","volume":"20","author":"Beaupre","year":"2005","journal-title":"J. Gen. Intern. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1493","DOI":"10.1136\/bmj.321.7275.1493","article-title":"Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: Results from overview of randomised trials","volume":"321","author":"Rodgers","year":"2000","journal-title":"BMJ"},{"key":"ref_11","first-page":"CD000521","article-title":"Anaesthesia for hip fracture surgery in adults","volume":"4","author":"Parker","year":"2001","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1001\/jamasurg.2019.4471","article-title":"Association of increasing use of spinal anesthesia in hip fracture repair with treating an aging patient population","volume":"155","author":"Maxwell","year":"2020","journal-title":"JAMA Surg."},{"key":"ref_13","first-page":"497","article-title":"Postoperative confusion after anesthesia in elderly patients with femoral neck fractures","volume":"66","author":"Berggren","year":"1987","journal-title":"Anesthesia Analg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1093\/bja\/59.5.561","article-title":"Influence of spinal and general anaesthesia on haemostasis during total hip arthroplasty","volume":"59","author":"Davis","year":"1987","journal-title":"Br. J. Anaesth."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1097\/00003643-199811000-00006","article-title":"Perioperative myocardial ischaemia in patients undergoing surgery for fractured hip randomized to incremental spinal, single-dose spinal or general anaesthesia","volume":"15","author":"Juelsgaard","year":"1998","journal-title":"Eur. J. Anaesthesiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1093\/bja\/52.1.49","article-title":"Comparison of the effects of spinal anaesthesia and general anaesthesia on postoperative oxygenation and perioperative mortality","volume":"52","author":"Mckenzie","year":"1980","journal-title":"Br. J. Anaesth."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/S0750-7658(86)80118-6","article-title":"Comparative study of general and spinal anesthesia in elderly women in hip surgery","volume":"5","author":"Racle","year":"1986","journal-title":"Ann. Fr. D\u2019anesthesie Reanim."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1097\/ALN.0b013e3182545e7c","article-title":"Comparative Effectiveness of Regional versus General Anesthesia for Hip Fracture Surgery in Adults","volume":"117","author":"Neuman","year":"2012","journal-title":"Anesthesiology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2025","DOI":"10.1056\/NEJMoa2113514","article-title":"Spinal Anesthesia or General Anesthesia for Hip Surgery in Older Adults","volume":"385","author":"Neuman","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_20","first-page":"217","article-title":"Does Anesthesia Type Affect Mortality Rates in Delayed Femoral Neck Fracture Surgery? A Retrospective Study","volume":"6","author":"Turkmen","year":"2022","journal-title":"Eurasian J. Med. Investig."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1444","DOI":"10.1007\/s00268-023-06949-y","article-title":"General anesthesia versus regional anesthesia in the elderly patients undergoing hip fracture surgeries: A systematic review and meta-analysis of randomized clinical trials","volume":"47","author":"Cao","year":"2023","journal-title":"World J. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1007\/s12630-024-02696-3","article-title":"Comparing perioperative outcomes between regional anesthesia and general anesthesia in patients undergoing hip fracture surgery: A systematic review and meta-analysis","volume":"71","author":"Liu","year":"2024","journal-title":"Can. J. Anesth\/J. Can. Anesth"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/9\/1446\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:48:18Z","timestamp":1760111298000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/9\/1446"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,4]]},"references-count":22,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2024,9]]}},"alternative-id":["medicina60091446"],"URL":"https:\/\/doi.org\/10.3390\/medicina60091446","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9,4]]}}}