S009: THE ASSOCIATION BETWEEN ANESTHESIA TECHNIQUES AND UNPLANNED HOSPITAL READMISSIONS IN FEMUR FRACTURE REPAIR IN THE US BETWEEN 2016 AND 2020
Emily Johnson, BS; Mary DesRosiers; Alexa Ovalles, BA; NC Barengo, MD, PhD, MPH; R Seetharamaiah, MD; L Perez, PhD, MBA, MLS; Herbert Wertheim College of Medicine
Introduction: Hip fracture repair is a common procedure with worldwide projection estimating a rise in the incidence of hip fractures from 1.66 million in 1990 to 6.26 million by 2050 (Cooper et al. 1992) anticipating a high rate of readmission to the hospital and mortality rate. There have been positive associations between more intensive anesthesia increasing the mortality rate as compared to more mild anesthesia practices. However, there is little research examining the effect on hospital readmission across various anesthetic techniques in hip fracture repairs.
Methods: This cross-sectional 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 femur fracture repair surgery. The outcome variable was hospital readmission within 30 days after surgery. The main independent variable anesthetic technique (general, MAC (sedation and local anesthesia), or regional (spinal and epidural)). Covariates included age, race, gender, smoking status, and comorbidities (diabetes, COPD, heart failure, renal failure, dialysis, and cancer). Multivariate logistic regression analysis was performed to calculate odds ratios (OR) and 95% confidence intervals (CI).
Results: Total sample population included 102,193 patients. Readmitted patients that received general anesthesia were 6,145 (8.5%), MAC 566 (7.5%), and regional 1,481 (6.6%). After adjusting for co-variates, patients receiving MAC/ IV sedation were less likely to undergo unplanned readmission as compared to those receiving general anesthesia [aOR= 0.91; 95% 0.85-0.98]; on the other hand, patients receiving regional anesthesia were more likely to be readmitted but it was not statistically significant [aOR=1.09; 95% CI 0.98-1.22]. Similarly, readmissions were more likely among African Americans [aOR= 1.13 CI 95% 1.01-1.27)] and insulin users [aOR= 1.41; CI 95% 1.26-1.56)].
Conclusion: There was an association between the use of MAC/IV sedation and lower readmission rates in patients undergoing femur fracture surgery. The results of the current investigation suggest that using MAC/IV sedation should be strongly considered as the anesthesia technique of choice to reduce the healthcare burden related to readmissions in patients who undergo hip fracture repair. Further research should address the variance in aesthetical technique across individual Current Procedural Terminology codes on hospital readmission.
Keywords: anesthesia; general anesthesia; spinal anesthesia; epidural; anesthesia technique; hip fracture; hip fracture repair; readmission