Semih BAŞKAN, Musa ZENGİN, Murat AKÇAY, Feryal KORKMAZ AKÇAY, Erman CEYHAN, Ali ALAGÖZ

Evaluation of the effects of two different anesthesia methods on postoperative renal functions in geriatric patients undergoing hip fracture surgery: a prospective randomized trial

Aim: The choice of anesthesia management for hip fracture surgery is among the modifiable risk factors that can affect the outcome. This study aims to investigate the effects of two different anesthesia techniques on kidney functions with the RIFLE (Risk, Injury, Failure, Loss, and End-stage renal failure) risk score in patients who were operated on for hip fracture. Material and Method: Serum creatinine values lower than 1.5 times (Normal value: 1.2 mg/dL) and glomerular filtration rate (GFR) below 60 mg/dl, over 65 years old, without serious comorbidity, hemoglobin (Hb) value over 9 g/dl 60 patients were included. The demographic data and biochemical parameters of the patients were recorded. The patients were randomized into two groups as spinal anesthesia (Group S) and general anesthesia (Group G). During the surgery, a urinary catheter was applied to the patients and urine output was monitored. Balance liquid electrolyte regimen was applied and after Hb control, an appropriate blood regimen was planned with Hb above 9 g/dl. Postoperatively, patients were followed at 6th, 12th, and 24th hours on the first day, and then at 24-hour intervals in the first postoperative week, and were evaluated with the RIFLE risk scores. Results: There was no statistically significant difference between the groups in terms of demographic data, fracture type, laboratory values, and urine volumes (p > 0.05). In the comparison of intragroup urea values, the decrease in the 5th time interval compared to the baseline value was statistically significant in Group G. There was no statistically significant difference between the measurement times in Group S (p > 0.05). Preoperative creatinine values were found to be statistically significantly higher than other measurement times in the patient group in Group S (p 0.05). Conclusion: There is no difference between the anesthesia method applied in hip fracture surgery and the change in renal function of patients, based on RIFLE criteria and laboratory parameters. In addition, a significant improvement in renal functions was observed in both groups, especially during the discharge period, according to preoperative values, which may indicate that the stress response to surgery can be effectively limited in both anesthesia methods.

Keywords:

General anesthesia spinal anesthesia, hip fracture, renal functions, geriatric, RIFLE, postoperative,

PDF

___

Karaca S, Ayhan E, Kesmezacar H, Uysal O. Hip fracture mortality: is it affected by anesthesia techniques? Anesthesiology Research and Practice 2012.doi: 10.1155/2012/708754
Ersoy A, Ervatan Z, Ali A, Kara D, Sağ E, Adaş M. Kalça cerrahisinde anestezi deneyimlerimiz. Okmeydanı Tıp Dergisi 2013; 29: 33-6.
Beaupre LA, Jones CA, Saunders LD, Johnston DW, Buckingham J, Majumdar SR. Best practices for elderly hip fracture patients. A systematic overview of the evidence. J Gen Intern Med 2005; 20: 1019-25.
Brox WT, Chan PH, Cafri G, Inacio MC. Similar mortality with general or regional anesthesia in elderly hip fracture patients. Acta Orthop 2016; 87: 152-7.
Rashid RH, Shah AA, Shakoor A, Noordin S. Hip fracture surgery: does type of anesthesia matter? Biomed Res Int. 2013; 2013: 252356.
Pugely AJ, Martin CT, Gao Y, Klocke NF, Callaghan JJ, Marsh JL. A risk calculator for short-term morbidity and mortality after hip fracture surgery. J Orthop Trauma 2014; 28: 63-9.
Patorno E, Neuman MD, Schneeweiss S, Mogun H, Bateman BT. Comparative safety of anesthetic type for hip fracture surgery in adults: retrospective cohort study. BMJ. 2014; 348: g4022.
Neuman MD, Silber JH, Elkassabany NM, Ludwig JM, Fleisher LA. Comparative effectiveness of regional versus general anesthesia for hip fracture surgery in adults. Anesthesiology 2012; 117: 72-92.
Azevedo VL, Silveira MA, Santos JN, Braz JR, Braz LG, Módolo NS. Postoperative renal function evaluation, through RIFLE criteria, of elderly patients who underwent femur fracture surgery under spinal anesthesia. Ren Fail 2008; 30: 485-90.
Singri N, Ahya SN, Levin ML. Acute renal failure. JAMA 2003; 289: 747-51.
Pedersen AB, Christiansen CF, Gammelager H, Kahlert J, Sørensen HT. Risk of acute renal failure and mortality after surgery for a fracture of the hip: a population-based cohort study. Bone Joint J 2016; 98-B: 1112-8.
Kateros K, Doulgerakis C, Galanakos SP, Sakellariou VI, Papadakis SA, Macheras GA. Analysis of kidney dysfunction in orthopaedic patients. BMC Nephrol 2012; 13: 101.
Ulucay C, Eren Z, Kaspar EC, et al. Risk factors for acute kidney injury after hip fracture surgery in the elderly individuals. Geriatr Orthop Surg Rehabil 2012; 3: 150-6.
Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P. Acute Dialysis Quality Initiative Workgroup. Acute renal failure-definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 2004; 8: R204-12.
Mullen JO, Mullen NL. Hip fracture mortality. A prospective, multifactorial study to predict and minimize death risk. Clin Orthop Relat Res 1992; 280: 214-22.
Gong Y, Zhang F, Ding F, Gu Y. Elderly patients with acute kidney injury (AKI): clinical features and risk factors for mortality. Arch Gerontol Geriatr 2012; 54: e47-51.
Bennet SJ, Berry OM, Goddard J, Keating JF. Acute renal dysfunction following hip fracture. Injury 2010; 41: 335-8.
Noyez L. Influence of the definition of acute renal failure post-cardiac surgery on incidence, patient identification, and identification of risk factors. Eur J Cardiothorac Surg 2011; 39: e8-12.
Abelha FJ, Botelho M, Fernandes V, Barros H. Determinants of postoperative acute kidney injury. Crit Care 2009; 13: R79.
Kheterpal S, Tremper KK, Englesbe MJ, et al. Predictors of postoperative acute renal failure after noncardiac surgery in patients with previously normal renal function. Anesthesiology 2007; 107: 892-902.
O’Hara DA, Duff A, Berlin JA, et al. The effect of anesthetic technique on postoperative outcomes in hip fracture repair. Anesthesiology 2000; 92: 947-57.
Desai V, Chan PH, Prentice HA, et al. Is anesthesia technique associated with a higher risk of mortality or complications within 90 days of surgery for geriatric patients with hip fractures? Clin Orthop Relat Res 2018; 476: 1178-88.
Hassan BK, Sahlström A, Dessau RB. Risk factors for renal dysfunction after total hip joint replacement; a retrospective cohort study. J Orthop Surg Res 2015; 10: 158.
Weingarten TN, Gurrieri C, Jarett PD, et al. Acute kidney injury following total joint arthroplasty: retrospective analysis. Can J Anaesth 2012; 59: 1111-8.
Parker MJ, Handoll HH, Griffiths R. Anaesthesia for hip fracture surgery in adults. Cochrane Database Syst Rev 2004; 4: CD000521. Update in: Cochrane Database Syst Rev 2016; 2: CD000521.
Zengin M, Dogan G, Karaca O, et al. Retrospective Review of Anesthesia Methods in Total Knee Arthroplasty Surgeries, Osmangazi Journal of Medicine 2021; 43: 633-9.
Weinberg L, Pritchard A, Louis M, Jones D, Hardidge A, Churilov L. Rapid response team activation after major hip surgery: A case series. Int J Surg Case Rep 2022; 90: 106699.
Desborough JP. The stress response to trauma and surgery. Br J Anaesth. 2000 Jul;85(1):109-17
Cusack B, Buggy DJ. Anaesthesia, analgesia, and the surgical stress response. BJA Educ 2020; 20: 321-8.
Kendrisic M, Surbatovic M, Djordjević D, Jevdjic J. Please cite this article: surgical stress response following hip arthroplasty regarding choice of anesthesia and postoperative analgesia. Vojnosanitetski Pregled (Military Medical Journal).doi: 10.2298/VSP160416153K.
Braüner Christensen J, Aasbrenn M, Sandoval Castillo L, et al. Predictors of acute kidney injury after hip fracture in older adults. Geriatr Orthop Surg Rehabil 2020; 11:2151459320920088.
Khetepal S, Tremper KK, Englesbe MJ, et al. Predictors of postoperative acute renal failure after noncardiac surgery in patients with previously normal renal function. Anesthesiology 2007; 107: 892-902.
Onuigbo MA, Agbasi N. Association of intraoperative hypotension with acute kidney injury after elective non-cardiac surgery-prevention is better than cure. Ren Fail 2016; 38: 168-9.
Rodgers A, Walker N, Schug S, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ 2000; 321: 1493.