Due to the rising life expectancy, the population in the industrial nations becomes older and older. In Germany the number of people over 65 years was 26% of the total population in 2013. This proportion is subject to constant growth and is estimated to be around 40% by 2040.
From a medical point of view, the older patients are a particular challenge for medical care. The number of hip fractures (e.g. fractures of the neck of the femur) increases continuously after minor falls. As a result, hospital stays among older patients are increasing. Due to the simultaneously increasing number of concomitant diseases, as well as the number of different medications and the increasing frailty (e.g. weight loss, exhaustion, walking and standing insecurity, muscle weakness, reduced physical activity, cognitive decline), this patient group shows an increased rate of complications as well as an increased mortality.
The anaesthetic care of patients during a hip surgery may vary. The surgery can be performed under general anesthesia or under spinal anesthesia. Both procedures are standard anaesthesia procedures, but have different advantages and disadvantages. With general anaesthesia, the patient is in a kind of deep sleep from the beginning to the end of the surgery. During anaesthesia, the anaesthetist monitors the patient’s health (blood pressure, pulse, blood values) and takes care of an adequate supply of oxygen (ventilation). In spinal anaesthesia, the physician anaesthetisises the spinal cord nerves and thus the patient is numbed from the navel downwards. As a result, movement of the legs is no longer possible and the patient does not feel any pain from the navel downwards. The patient is awake and breathes independently. During the surgery it is possible to give the patient sedation medication for a light sleep. This enables to shield the patient from the ambient sounds. However, there is currently no clear data showing that one of the two procedures is superior to the other. After the surgery, all patients show an increased risk of a state of confusion (delirium) and pulmonary complications (e.g. pneumonia). The iHOPE study will investigate, whether there is a difference in the complication rates and thus standardize and improve the care of this valuable patient good.
Within the framework of the study, all patients with a broken hip (intra- and extracapsular hip fractures) will be screened by the research staff in the participating clinics. In case the patients fit into the study, the procedure, the risks and also the aim of the study will be explained to the patients and their relatives. This means that they are randomly assigned to one of the two anaesthesia procedures. Further medical care (anaesthesiological and surgical) will be provided according to usual clinical standards. During the hospital stay, the study team will only visit the patient to record important data. After hospital discharge three telephone calls (after 30, 180 and 365 days) will be performed to assess further important data. The usual care (discharge, follow-up treatment, etc.) is unaffected by the study.