Journal of orthopaedic trauma · 2025
Monitored Anesthesia Care-Soft Tissue Infiltration With Local Anesthesia (MAC-STILA) Decreases Incidence of Short-Term Postoperative Altered Mental Status in Patients With Hip Fracture.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Fisher Nina D, Kingery Matthew T, Merrell Lauren, Kadiyala Manasa L, Reider Lisa, Ganta Abhishek, Egol Kenneth A, Konda Sanjit R
Аннотация
OBJECTIVE: To determine whether the occurrence of short-term postoperative altered mental status (AMS) was lower in geriatric patients undergoing operative repair of hip fractures with Monitored Anesthesia Care and Soft Tissue Infiltration with Local Anesthesia (MAC-STILA) when compared with those undergoing operative repair of hip fractures with general anesthesia (GA).
DESIGN: Retrospective cohort study.
SETTING: Two US hospitals within a single academic medical center.
PATIENT SELECTION CRITERIA: Geriatric patients with hip fractures (AO/OTA 31A and 31B) undergoing operative repair were identified. Propensity matching was performed in a 1:2 ratio to minimize selection bias (age, sex, body mass index, American Society of Anesthesiology class, fracture pattern, fixation construct, preinjury ambulatory status, and assistive device use).
OUTCOME MEASURES: Patients who underwent surgical fixation with MAC-STILA were compared with those who underwent surgical fixation with GA. Primary outcome was postoperative AMS, defined as missing ≥1 items on the alert and oriented assessment (person, place, and time) at any point from postoperative days 0-3.
RESULTS: After matching, 228 patients (76 MAC-STILA: 152 GA) were included in the analysis. The average age of patients in both groups was 83 years. In the MAC-STILA group, 62% were women and 33% had baseline dementia, while in the GA group 66% were women and 29% had baseline dementia. Treating patients with MAC-STILA was associated with 72% lower odds of having AMS than treating patients with GA, controlling for baseline comorbidity and dementia (odds ratio: 0.28. 95% confidence interval: 0.09-0.075, P = 0.016). Among patients with baseline dementia, the rate of AMS was lower in patients treated with MAC-STILA than in patients treated with GA (64.0% vs. 95.3%, P = 0.001).
CONCLUSIONS: MAC-STILA was associated with lower odds of short-term postoperative AMS than GA in patients with hip fracture undergoing operative repair. Given the high rate of postoperative AMS and complications associated with a geriatric patient with hip fracture, MAC-STILA should be considered for use in patients with increased risk of postoperative AMS, particularly in the setting of preoperative dementia.
LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
DESIGN: Retrospective cohort study.
SETTING: Two US hospitals within a single academic medical center.
PATIENT SELECTION CRITERIA: Geriatric patients with hip fractures (AO/OTA 31A and 31B) undergoing operative repair were identified. Propensity matching was performed in a 1:2 ratio to minimize selection bias (age, sex, body mass index, American Society of Anesthesiology class, fracture pattern, fixation construct, preinjury ambulatory status, and assistive device use).
OUTCOME MEASURES: Patients who underwent surgical fixation with MAC-STILA were compared with those who underwent surgical fixation with GA. Primary outcome was postoperative AMS, defined as missing ≥1 items on the alert and oriented assessment (person, place, and time) at any point from postoperative days 0-3.
RESULTS: After matching, 228 patients (76 MAC-STILA: 152 GA) were included in the analysis. The average age of patients in both groups was 83 years. In the MAC-STILA group, 62% were women and 33% had baseline dementia, while in the GA group 66% were women and 29% had baseline dementia. Treating patients with MAC-STILA was associated with 72% lower odds of having AMS than treating patients with GA, controlling for baseline comorbidity and dementia (odds ratio: 0.28. 95% confidence interval: 0.09-0.075, P = 0.016). Among patients with baseline dementia, the rate of AMS was lower in patients treated with MAC-STILA than in patients treated with GA (64.0% vs. 95.3%, P = 0.001).
CONCLUSIONS: MAC-STILA was associated with lower odds of short-term postoperative AMS than GA in patients with hip fracture undergoing operative repair. Given the high rate of postoperative AMS and complications associated with a geriatric patient with hip fracture, MAC-STILA should be considered for use in patients with increased risk of postoperative AMS, particularly in the setting of preoperative dementia.
LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.