The effect of anesthesia technique on morbidity and mortality in patients over 65 years of age undergoing lower extremity surgery

This study aimed to show the effects of anesthesia approach on morbidity and mortality in geriatric patients who underwent orthopedic surgery. For this reason, the files of patients aged 65 and over who underwent surgery at Fırat University Hospital Orthopedics Clinic between September 2020 and September 2021 were retrospectively examined. Demographic data of the patients, American Society of Anesthesiologist (ASA) score, anesthesia type, surgeries, surgery and anesthesia durations, intraoperative events, postoperative complications, need for intensive care, total length of stay in hospital and intensive care, presence of comorbidities and 30-day and 1-year mortality has been recorded. A total of 350 patients, 214 (61.1%) women and 136 (38.9%) men, were included in the study. The average age of the patients is 76.8±8.6 (min=65-max=101) years. 46.9% of the patients are between the ages of 65-74, 32.3% are between the ages of 75-84 and 20.9% are aged 85 and over. 78.6% of the surgeries were performed with general, 13.7% with neuraxial block and 7.7% with peripheral block. When the ASAs of the patients are examined, 1.4% are ASA 1, 12.9% are ASA 2, 76.6% are ASA 3 and 9.1% are ASA 4. 54.8% of the patients were operated on the hip area, 27.1% were operated on the knee area, and the rest were operated on other areas. As a result, in this study, advanced age and ASA score are the parameters affecting mortality in geriatric lower extremity surgeries. In our study, it was observed that there was a significant increase in 30-day and 1-year mortality with increasing ASA scores. At the same time, it was observed that there was a significant increase in 30-day and 1-year mortality rates with increasing age. No statistically significant difference was found between mortality rates in cases according to anesthesia types. No significant difference was found in the length of hospital and intensive care stay and postoperative complications (except for the need for transfusion) according to the type of anesthesia. In our study, the need for transfusion and intensive care was found to be higher in patients receiving peripheral blocks. We think that this is due to the fact that the patients who received peripheral blocks in our clinic are very elderly, have many comorbidities, and are included in the group of patients who have undergone hip surgery. According to these results; In determining the anesthesia technique to be applied to elderly patients; The preoperative condition of the patient, the characteristics of the surgery, the possible complications of each technique, and the experience of the anesthetist should be taken into account. Long-term survival is affected by the patient's additional systemic diseases and the age of the patient rather than the anesthesia technique chosen. Conducted retrospectively in a single center; We think that this study, which examines anesthesia methods in the elderly and their effects on survival, can be a database for similar studies to be conducted in the future and that multicenter studies should be conducted on this subject. Key Words: Geriatrics, General Anesthesia, Regional Anesthesia, Mortality