The Relationship Between Duration of General Anesthesia and Postoperative Fall Risk During Hospital Stay in Orthopedic Patients

Influence of regional anesthesia on fall risk in adults over 60 years

BACKGROUND

Age-related changes can influence gait and contribute to a higher fall risk. Other influencing factors might be certain anesthetic procedures which affect therapeutic decisions. The study's goal was to evaluate whether brachial plexus blockade impacts the postoperative fall risk in adults ≥60 years.

METHODS

40 adults ≥60 years without predisposing fall risk factors receiving brachial plexus blockade were included. Gait parameters during single- and dual-task conditions were assessed using the GAITRite® walkway at three measurement points: preoperatively, within 24 h, and two weeks postoperatively. Additionally, a geriatric assessment including Berg Balance Scale, Timed Up and Go test and Montreal Cognitive Assessment was conducted, alongside pain intensity via Numeric Rating Scale. Statistical analysis involved ANOVA with repeated measures.

FINDINGS

All gait parameters showed a performance reduction within 24 h. Significant changes occurred during single-task in stride length (P = 0.018) and stride width variability (P < 0.01), further during dual-task in stride width (P = 0.015) and velocity (P = 0.039). Notable changes were also observed in the Berg Balance Scale (P < 0.0001), the Timed Up and Go test (P < 0.001), and Montreal Cognitive Assessment (P = 0.037). After two weeks the study parameters returned to the performance prior to surgery. Performance declined with increasing age. Pain intensity remained low.

INTERPRETATION

While brachial plexus blockade offers various advantages for patients due to its tolerability and controllability an increased gait instability and thus fall risk within the first postoperative day must be considered especially in older adults.

Should high-risk patients seek out care from high-volume surgeons?

Aims

Patients with a high comorbidity burden (HCB) can achieve similar improvements in quality of life compared with low-risk patients, but greater morbidity may deter surgeons from operating on these patients. Whether surgeon volume influences total hip arthroplasty (THA) outcomes in HCB patients has not been investigated. This study aimed to compare complication rates and implant survivorship in HCB patients operated on by high-volume (HV) and non-HV THA surgeons.

Methods

Patients with Charlson Comorbidity Index ≥ 5 and American Society of Anesthesiologists grade of III or IV, undergoing primary elective THA between January 2013 and December 2021, were retrospectively reviewed. Patients were separated into groups based on whether they were operated on by a HV surgeon (defined as the top 25% of surgeons at our institution by number of primary THAs per year) or a non-HV surgeon. Groups were propensity-matched 1:1 to control for demographic variables. A total of 1,134 patients were included in the matched analysis. Between groups, 90-day readmissions and revisions were compared, and Kaplan-Meier analysis was used to evaluate implant survivorship within the follow-up period.

Results

Years of experience were comparable between non-HV and HV surgeons (p = 0.733). The HV group had significantly shorter surgical times (p < 0.001) and shorter length of stay (p = 0.009) than the non-HV group. The HV group also had significantly fewer 90-day readmissions (p = 0.030), all-cause revisions (p = 0.023), and septic revisions (p = 0.020) compared with the non-HV group at latest follow-up. The HV group had significantly greater freedom from all-cause (p = 0.023) and septic revision (p = 0.020) than the non-HV group.

Conclusion

The HCB THA patients have fewer 90-day readmissions, all-cause revisions, and septic revisions, as well as shorter length of stay when treated by HV surgeons. THA candidates with a HCB may benefit from referral to HV surgeons to reduce procedural risk and improve postoperative outcomes.

Procedure Duration, Time Under Anesthesia, and Readmissions in Direct Anterior and Posterior Approach Total Hip Arthroplasty

BACKGROUND

Operative time is related to complications in primary total hip arthroplasty (THA). This study compared operative time in direct anterior (DA) and posterior approach THA and whether differences were related to increased hospital readmissions within 90 days of discharge.

METHODS

Prospectively documented data on 3,152 consecutively performed THAs by 16 surgeons at a large Midwestern United States academic healthcare system were retrospectively reviewed. All surgeons were beyond their learning curve. Cases characterized by factors extending operative time were excluded. A total of 1,235 analysis cases were performed with the DA approach and 1,608 with the posterior approach. DA patients had lower mean body mass index (P < .001), were more likely to be classified as American Society of Anesthesiologists Physical Status 1 or 2 (P < .001), and more likely to have surgery in an ambulatory setting (P < .001).

RESULTS

Time under anesthesia was significantly longer for DA procedures by 19 to 27 minutes in hospital and ambulatory settings, respectively (P < .001). Increasing body mass index had a greater impact on anesthesia time for DA patients (P = .020). There were no differences in nontraumatic readmissions within 90 days of surgery based on surgical approach (P ≥ .480); however, significantly more DA patients classified as ASA-PS 3 or 4 were readmitted compared to those classified as ASA-PS 1 or 2 (P < .001), a difference not observed for posterior approach patients.

CONCLUSION

Anesthesia time is a modifiable risk factor for patient safety and an important factor in healthcare resource utilization. Consideration of ways to reduce DA operative times is encouraged.