Outcome after anesthesia and orthopedic surgery in patients nonagenarians and centenarians

Abstract

Background: As life expectancy increases, the number of geriatric patients coming for surgery and anesthesia will make up an increasing portion of our practice. Nonagenarians and centenarians are a rapidly growing segment of the population. A hip fracture is a significant injury for anyone, but for older people it can be catastrophic. No previous study has used a national database to compare outcomes in these patients to those of other groups undergoing femur surgical procedures. Methods: Between January 2012 and December 2013 inclusive, 47 patients (13 men and 34 women) aged 90 years and older (range, 90-107 years) with hip fracture were prospectively analyzed. Information on the preoperative condition of these patients, mode of anesthesia, drugs used, intra-operatively measured variables (e.g. hemodynamics, blood loss) and immediate post-operative variables measured in the post-anesthesia care unit (PACU), and first day of postoperative was obtained from the study protocol. Results: Prior to injury, all of the patients were living at home. The average hospital stay until the day of surgery was 6.04 ± 2.77 days. The mean fasting time was 2:56 ± 0:38 hours. All patients were submitted to spinal anesthesia. The dose ranged from 6 to 15 mg, with a mean of 10 ± 2:43 mg isobaric bupivacaine. The duration of the spinal block was 2:56 ± 0:45 hours, the time for the use of dextrinomaltose was 2:14 ± 1:07 hours, the time in the PACU was 2:01 ± 0:43 hours and the time to reintroduce normal meals were 6:33 ± 1:03 hours. Arterial hypotension occurred in 3 patients and delirium in 5 patients. There were no deaths directly related to anesthesia or surgery. Conclusion: Our prospective analysis shows that the nonagenarians and centenarians tolerated anesthesia and surgery, and can fully participate in projects accelerated postoperative recovery.