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Abstract：
Hip fracture is a trauma of the elderly. The worldwide number of patients in need of surgery after hip fracture will increase in the coming years. The 30-day mortality ranges between 4 and 14%. Patients\' outcome may be improved by anaesthesia technique (general vs. neuraxial anaesthesia). There is a dearth of evidence from randomised studies regarding to the optimal anaesthesia technique. However, several large non-randomised studies addressing this question have been published from the onset of 2010.
To compare the 30-day mortality rate, in-hospital mortality rate and length of hospital stay after neuraxial (epidural/spinal) or general anaesthesia in hip fracture patients (≥ 18 years old) we prepared a systematic review and meta-analysis. A systematic search for appropriate retrospective observational and prospective randomised studies in Embase and PubMed databases was performed in the time-period from 01.01.2010 to 21.11.2016. Additionally a forward searching in google scholar, a level one reference list searching and a formal searching of trial registries was performed.
Twenty retrospective observational and three prospective randomised controlled studies were included. There was no difference in the 30-day mortality [OR 0.99; 95% CI (0.94 to 1.04), p = 0.60] between the general and the neuraxial anaesthesia group. The in-hospital mortality [OR 0.85; 95% CI (0.76 to 0.95), p = 0.004] and the length of hospital stay were significantly shorter in the neuraxial anaesthesia group [MD -0.26; 95% CI (-0.36 to -0.17); p < 0.00001].
Neuraxial anaesthesia is associated with a reduced in-hospital mortality and length of hospitalisation. However, type of anaesthesia did not influence the 30-day mortality. In future there is a need for large randomised studies to examine the association between the type of anaesthesia, post-operative complications and mortality.
To compare the 30-day mortality rate, in-hospital mortality rate and length of hospital stay after neuraxial (epidural/spinal) or general anaesthesia in hip fracture patients (≥ 18 years old) we prepared a systematic review and meta-analysis. A systematic search for appropriate retrospective observational and prospective randomised studies in Embase and PubMed databases was performed in the time-period from 01.01.2010 to 21.11.2016. Additionally a forward searching in google scholar, a level one reference list searching and a formal searching of trial registries was performed.
Twenty retrospective observational and three prospective randomised controlled studies were included. There was no difference in the 30-day mortality [OR 0.99; 95% CI (0.94 to 1.04), p = 0.60] between the general and the neuraxial anaesthesia group. The in-hospital mortality [OR 0.85; 95% CI (0.76 to 0.95), p = 0.004] and the length of hospital stay were significantly shorter in the neuraxial anaesthesia group [MD -0.26; 95% CI (-0.36 to -0.17); p < 0.00001].
Neuraxial anaesthesia is associated with a reduced in-hospital mortality and length of hospitalisation. However, type of anaesthesia did not influence the 30-day mortality. In future there is a need for large randomised studies to examine the association between the type of anaesthesia, post-operative complications and mortality.
摘要：
髋部骨折是老年人的创伤。未来几年，全世界髋部骨折后需要手术的患者数量将增加。30天死亡率介于4%和14%之间。患者的预后可通过麻醉技术得到改善(一般与神经轴麻醉)。关于最佳麻醉技术的随机研究缺乏证据。然而,从2010年开始,已经发表了几项针对这一问题的大型非随机研究.
为了比较30天死亡率，我们对髋部骨折患者(≥18岁)进行了系统评价和荟萃分析,比较了椎管内(硬膜外/脊髓)或全身麻醉后的住院死亡率和住院时间.在2010年01.01月至2016年11月21日期间，在Embase和PubMed数据库中进行了适当的回顾性观察性和前瞻性随机研究的系统搜索。此外，在谷歌学者中进行了正向搜索，我们进行了一级参考列表搜索和正式的试验登记处搜索.
纳入20项回顾性观察性研究和3项前瞻性随机对照研究。30天死亡率没有差异[OR0.99;95％CI（0.94至1.04），一般和神经轴麻醉组之间的p=0.60]。住院死亡率[OR0.85；95%CI（0.76至0.95），p=0.004]，神经轴麻醉组的住院时间明显缩短[MD-0.26；95％CI（-0.36至-0.17）；p<0.00001]。
神经轴麻醉与降低住院死亡率和住院时间有关。然而,麻醉类型不影响30日死亡率.在未来，有必要进行大型随机研究，以检查麻醉类型之间的关联，术后并发症和死亡率。
为了比较30天死亡率，我们对髋部骨折患者(≥18岁)进行了系统评价和荟萃分析,比较了椎管内(硬膜外/脊髓)或全身麻醉后的住院死亡率和住院时间.在2010年01.01月至2016年11月21日期间，在Embase和PubMed数据库中进行了适当的回顾性观察性和前瞻性随机研究的系统搜索。此外，在谷歌学者中进行了正向搜索，我们进行了一级参考列表搜索和正式的试验登记处搜索.
纳入20项回顾性观察性研究和3项前瞻性随机对照研究。30天死亡率没有差异[OR0.99;95％CI（0.94至1.04），一般和神经轴麻醉组之间的p=0.60]。住院死亡率[OR0.85；95%CI（0.76至0.95），p=0.004]，神经轴麻醉组的住院时间明显缩短[MD-0.26；95％CI（-0.36至-0.17）；p<0.00001]。
神经轴麻醉与降低住院死亡率和住院时间有关。然而,麻醉类型不影响30日死亡率.在未来，有必要进行大型随机研究，以检查麻醉类型之间的关联，术后并发症和死亡率。
