What is a good anaesthetic for hip fracture?
Research type
Research Study
Full title
What is a 'good anaesthetic? Producing evidence in complex settings: the case of fractured neck of femur.
IRAS ID
193273
Contact name
Clifford L Shelton
Contact email
Sponsor organisation
Lancaster University
Duration of Study in the UK
2 years, 5 months, 30 days
Research summary
Approximately 70,000 cases of hip fracture occur in England every year, and this is projected to rise to around 100,000 cases over the next twenty years. The majority of hip fractures are sustained by elderly people, and the average age of a hip fracture patient is 82 years. People who sustain a hip fracture have a 10 percent chance of death within the 30 days following injury, and it is likely that those who survive a hip fracture will experience a substantial deterioration in their general health. As a consequence of this, over a third of patients with hip fractures who are admitted from their own home are unable to return to independent living on discharge from hospital. The high risk of death or significant deterioration in health means that doctors must find ways to provide the best possible care for this group of patients.
In order to allow a hip fracture to be fixed, nearly all patients have an operation, and this requires an anaesthetic. Two types of anaesthetic can be used for hip fracture surgery: general anaesthesia in which the patient is unconscious throughout surgery, and regional anaesthesia in which the patient’s legs are numbed temporarily, but the patient remains awake. Considerable research effort has focussed on determining if some types of anaesthesia are safer than others, however high-quality scientific studies have so far failed to demonstrate that this is the case. Whilst this could indicate that the anaesthetic technique does not matter, existing studies’ division of anaesthesia into ‘general’ or ‘regional’ provides insufficient information about what treatment each patient is actually undergoing, and this makes existing data unreliable. For example, there are at least five different injections and three different gases in use in the UK that can all induce general anaesthesia, and these drugs are often used in different ways and different combinations by different anaesthetists, for different patients. In short, one anaesthetic of a given type is not the same as the next.
In considering these issues, the authors of the most recent large study of anaesthesia for hip fracture surgery suggested that it is important to obtain further information about what a ‘good’ or a ‘bad’ anaesthetic involves, rather than to simply focus on the type of anaesthetic given. In addition, NICE has noted that there is not enough scientific information about what is important in hip fracture anaesthesia from the patients’ perspective, and has suggested that this should be a priority for research. We therefore propose to investigate the concept of a ‘good anaesthetic’ for hip fracture surgery from the perspective of all three key stakeholders in the operation: the patient, the anaesthetist, and the surgeon. In order to gain a deep understanding of the issues we will use a number of research techniques including interviews with patients and staff, direct observation of anaesthetic practice, and focus group discussions to build an in-depth understanding of the factors that influence the quality and safety of the anaesthetic management of this challenging patient group.REC name
Wales REC 7
REC reference
16/WA/0105
Date of REC Opinion
31 Mar 2016
REC opinion
Favourable Opinion