Feasibility of epidural catheter as primary anaesthesia in patients with hip fracture

Gideon F. Strange; Christian V. Nielsen; Anne H. Nielsen; Eva N. Glassou; Christina F. Frandsen

doi:10.1097/IO9.0000000000000072

Feasibility of epidural catheter as primary anaesthesia in patients with hip fracture

Gideon F. Strange^*, Christian V. Nielsen, Anne H. Nielsen, Eva N. Glassou, Christina F. Frandsen

^*Corresponding author for this work

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

Abstract

Introduction: Danish national guidelines advocate preoperative optimization within 4 h and surgical intervention within 24 h for hip fracture patients, a goal often unmet. This study assesses the feasibility of universal epidural administration, aiming to achieve adherence to these guidelines. Method: Data from the Danish Interdisciplinary Registry of Hip Fractures (March–May and September–November 2022) at Gødstrup Hospital were analyzed. Patients aged 65 and above were included, with a focus on achieving 75% compliance for epidural administration as the primary surgical anesthesia. Journal audits explored patient characteristics, excluding those with epidural contraindications. Results: Out of 121 patients administered an epidural, 79% had it as their primary surgical anesthesia. Patient characteristics were comparable between those maintaining and altering the epidural method. Notably, 61% of epidural patients were ready for surgery within 4 h, and 91% underwent surgery within 24 h, aligning with guideline recommendations. However, adherence to the 4 h preoperative optimization guideline was incomplete. Comparisons with alternative anesthesia approaches showed no significant differences in preoperative optimization and surgical intervention times. Conclusion: This study demonstrates the feasibility of a fast-track regime with a preoperative epidural catheter, with 79% adherence to the planned use of epidural as the primary surgical anesthesia. This approach allows for early optimal pain relief without delaying surgery, showcasing potential improvements in adhering to guideline recommendations, especially in achieving timely surgical interventions for hip fracture patients.

Original language	English
Journal	International Journal of Surgery Open
Volume	62
Issue	4
Pages (from-to)	418-423
Number of pages	6
ISSN	2405-8572
DOIs	https://doi.org/10.1097/IO9.0000000000000072
Publication status	Published - May 2024

Keywords

Anesthesia
epidural catheter
feasibility
hip fracture
orthopedic surgery
pain

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10.1097/IO9.0000000000000072

Cite this

@article{743a8c021f4b4f92a5a1c477dc479fc7,

title = "Feasibility of epidural catheter as primary anaesthesia in patients with hip fracture",

abstract = "Introduction: Danish national guidelines advocate preoperative optimization within 4 h and surgical intervention within 24 h for hip fracture patients, a goal often unmet. This study assesses the feasibility of universal epidural administration, aiming to achieve adherence to these guidelines. Method: Data from the Danish Interdisciplinary Registry of Hip Fractures (March–May and September–November 2022) at G{\o}dstrup Hospital were analyzed. Patients aged 65 and above were included, with a focus on achieving 75% compliance for epidural administration as the primary surgical anesthesia. Journal audits explored patient characteristics, excluding those with epidural contraindications. Results: Out of 121 patients administered an epidural, 79% had it as their primary surgical anesthesia. Patient characteristics were comparable between those maintaining and altering the epidural method. Notably, 61% of epidural patients were ready for surgery within 4 h, and 91% underwent surgery within 24 h, aligning with guideline recommendations. However, adherence to the 4 h preoperative optimization guideline was incomplete. Comparisons with alternative anesthesia approaches showed no significant differences in preoperative optimization and surgical intervention times. Conclusion: This study demonstrates the feasibility of a fast-track regime with a preoperative epidural catheter, with 79% adherence to the planned use of epidural as the primary surgical anesthesia. This approach allows for early optimal pain relief without delaying surgery, showcasing potential improvements in adhering to guideline recommendations, especially in achieving timely surgical interventions for hip fracture patients.",

keywords = "Anesthesia, epidural catheter, feasibility, hip fracture, orthopedic surgery, pain",

author = "Strange, {Gideon F.} and Nielsen, {Christian V.} and Nielsen, {Anne H.} and Glassou, {Eva N.} and Frandsen, {Christina F.}",

note = "Publisher Copyright: Copyright {\textcopyright} 2024 The Author(s). Published by Wolters Kluwer Health, Inc.",

year = "2024",

month = may,

doi = "10.1097/IO9.0000000000000072",

language = "English",

volume = "62",

pages = "418--423",

journal = "International Journal of Surgery Open",

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Feasibility of epidural catheter as primary anaesthesia in patients with hip fracture. / Strange, Gideon F.; Nielsen, Christian V.; Nielsen, Anne H. et al.
In: International Journal of Surgery Open, Vol. 62, No. 4, 05.2024, p. 418-423.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Feasibility of epidural catheter as primary anaesthesia in patients with hip fracture

AU - Strange, Gideon F.

AU - Nielsen, Christian V.

AU - Nielsen, Anne H.

AU - Glassou, Eva N.

AU - Frandsen, Christina F.

PY - 2024/5

Y1 - 2024/5

N2 - Introduction: Danish national guidelines advocate preoperative optimization within 4 h and surgical intervention within 24 h for hip fracture patients, a goal often unmet. This study assesses the feasibility of universal epidural administration, aiming to achieve adherence to these guidelines. Method: Data from the Danish Interdisciplinary Registry of Hip Fractures (March–May and September–November 2022) at Gødstrup Hospital were analyzed. Patients aged 65 and above were included, with a focus on achieving 75% compliance for epidural administration as the primary surgical anesthesia. Journal audits explored patient characteristics, excluding those with epidural contraindications. Results: Out of 121 patients administered an epidural, 79% had it as their primary surgical anesthesia. Patient characteristics were comparable between those maintaining and altering the epidural method. Notably, 61% of epidural patients were ready for surgery within 4 h, and 91% underwent surgery within 24 h, aligning with guideline recommendations. However, adherence to the 4 h preoperative optimization guideline was incomplete. Comparisons with alternative anesthesia approaches showed no significant differences in preoperative optimization and surgical intervention times. Conclusion: This study demonstrates the feasibility of a fast-track regime with a preoperative epidural catheter, with 79% adherence to the planned use of epidural as the primary surgical anesthesia. This approach allows for early optimal pain relief without delaying surgery, showcasing potential improvements in adhering to guideline recommendations, especially in achieving timely surgical interventions for hip fracture patients.

AB - Introduction: Danish national guidelines advocate preoperative optimization within 4 h and surgical intervention within 24 h for hip fracture patients, a goal often unmet. This study assesses the feasibility of universal epidural administration, aiming to achieve adherence to these guidelines. Method: Data from the Danish Interdisciplinary Registry of Hip Fractures (March–May and September–November 2022) at Gødstrup Hospital were analyzed. Patients aged 65 and above were included, with a focus on achieving 75% compliance for epidural administration as the primary surgical anesthesia. Journal audits explored patient characteristics, excluding those with epidural contraindications. Results: Out of 121 patients administered an epidural, 79% had it as their primary surgical anesthesia. Patient characteristics were comparable between those maintaining and altering the epidural method. Notably, 61% of epidural patients were ready for surgery within 4 h, and 91% underwent surgery within 24 h, aligning with guideline recommendations. However, adherence to the 4 h preoperative optimization guideline was incomplete. Comparisons with alternative anesthesia approaches showed no significant differences in preoperative optimization and surgical intervention times. Conclusion: This study demonstrates the feasibility of a fast-track regime with a preoperative epidural catheter, with 79% adherence to the planned use of epidural as the primary surgical anesthesia. This approach allows for early optimal pain relief without delaying surgery, showcasing potential improvements in adhering to guideline recommendations, especially in achieving timely surgical interventions for hip fracture patients.

KW - Anesthesia

KW - epidural catheter

KW - feasibility

KW - hip fracture

KW - orthopedic surgery

KW - pain

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DO - 10.1097/IO9.0000000000000072

M3 - Journal article

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SN - 2405-8572

VL - 62

SP - 418

EP - 423

JO - International Journal of Surgery Open

JF - International Journal of Surgery Open

IS - 4

ER -

Feasibility of epidural catheter as primary anaesthesia in patients with hip fracture

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Keywords

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