MAC-STILA

Author

Kingery MT

Published

June 1, 2023

Demographics

Table 1: Baseline Demographics
Characteristic Group p-value2
MAC-STILA, N = 791 General Anesthesia, N = 1581
Age 82.9 +/- 10.5 82.6 +/- 10.6 0.798
Sex 0.925
    Male 30 (38.0%) 61 (38.6%)
    Female 49 (62.0%) 97 (61.4%)
BMI 24.5 +/- 4.9 24.3 +/- 5.2 0.805
ASA 0.228
    0 2 (2.5%) 0 (0.0%)
    2 9 (11.4%) 19 (12.0%)
    3 51 (64.6%) 111 (70.3%)
    4 17 (21.5%) 28 (17.7%)
Marital Status <0.001
    Single 22 (27.8%) 44 (28.8%)
    Married 18 (22.8%) 51 (33.3%)
    Divorced 23 (29.1%) 9 (5.9%)
    Widowed 16 (20.3%) 49 (32.0%)
CCI 1.6 +/- 1.6 2.1 +/- 1.9 0.033
Independent at Baseline 42 (53.2%) 100 (63.3%) 0.134
Baseline Dementia 24 (30.4%) 34 (21.5%) 0.135
Baseline Ambulatory Status 0.923
    Community 51 (64.6%) 103 (65.2%)
    Household 28 (35.4%) 55 (34.8%)
Baseline Assistive Device 60 (75.9%) 125 (79.1%) 0.579
Preoperative Anticoagulation 23 (29.1%) 48 (30.4%) 0.841
Fracture Pattern 0.889
    31A 69 (87.3%) 139 (88.0%)
    31B 10 (12.7%) 19 (12.0%)
Implant 0.902
    CRPP 7 (8.9%) 12 (7.6%)
    Short CMN 66 (83.5%) 132 (83.5%)
    Long CMN 6 (7.6%) 14 (8.9%)
1 Mean +/- SD; n (%)
2 One-way ANOVA; Pearson's Chi-squared test; Fisher's Exact Test for Count Data with simulated p-value (based on 2000 replicates)

Intraoperative Vitals

Table 2: Intraoperative Vitals and Labs
Characteristic Group p-value2
MAC-STILA, N = 791 General Anesthesia, N = 1581
Respiratory rate (minimum) 8.8 +/- 4.5 4.4 +/- 2.9 <0.001
Respiratory rate (maximum) 29.4 +/- 6.6 24.2 +/- 7.0 <0.001
Systolic BP (minimum) 96.4 +/- 18.4 83.4 +/- 16.2 <0.001
Systolic BP (maximum) 160.9 +/- 24.6 163.3 +/- 25.8 0.486
Diastolic BP (minimum) 52.9 +/- 9.7 45.2 +/- 10.6 <0.001
Diastolic BP (maximum) 93.2 +/- 13.5 96.0 +/- 20.4 0.202
HR (minimum) 60.8 +/- 8.9 63.4 +/- 13.1 0.079
HR (maximum) 107.8 +/- 21.2 168.8 +/- 834.6 0.361
Postoperative hemoglobin 9.2 +/- 2.0 9.3 +/- 2.4 0.871
Preoperative hemoglobin 11.3 +/- 1.8 11.4 +/- 1.9 0.744
ETCO2 (mean) 22.7 +/- 5.7 29.9 +/- 6.0 <0.001
ETCO2 (minimum) 3.5 +/- 5.4 5.0 +/- 10.4 0.158
ETCO2 (maximum) 34.9 +/- 9.7 42.1 +/- 7.6 <0.001
1 Mean +/- SD
2 Welch Two Sample t-test

Pain

Table 3: Perioperative VAS Pain Score
Characteristic Group p-value2
MAC-STILA, N = 791 General Anesthesia, N = 1581
8 hours 1.7 +/- 2.6 1.8 +/- 3.1 0.954
16 hours 3.2 +/- 3.4 4.0 +/- 3.4 0.209
24 hours 3.5 +/- 3.7 4.3 +/- 3.3 0.168
48 hours 3.9 +/- 3.6 4.4 +/- 3.1 0.398
1 Mean +/- SD
2 Welch Two Sample t-test

Postoperative Complications

Table 4: Complications and Mortality
Characteristic Group p-value2
MAC-STILA, N = 791 General Anesthesia, N = 1581
Hypotension 6 (7.6%) 16 (10.1%) 0.527
Shock 3 (3.8%) 3 (1.9%) 0.403
Pneumonia 6 (7.6%) 7 (4.4%) 0.367
DVT 1 (1.3%) 1 (0.6%) >0.999
COPD exacerbation 2 (2.5%) 2 (1.3%) 0.602
MI 1 (1.3%) 1 (0.6%) >0.999
AKI 7 (8.9%) 20 (12.7%) 0.386
CVI 1 (1.3%) 2 (1.3%) >0.999
Surgical site infection 3 (3.8%) 0 (0.0%) 0.036
Decubitus ulcer 1 (1.3%) 5 (3.2%) 0.667
UTI 8 (10.1%) 11 (7.0%) 0.398
Respiratory failure 6 (7.6%) 7 (4.4%) 0.367
Anemia 33 (41.8%) 59 (37.3%) 0.509
Cardiac arrest 0 (0.0%) 3 (1.9%) 0.553
Death during admission 1 (1.3%) 4 (2.5%) 0.667
30-day mortality 8 (10.1%) 4 (2.5%) 0.023
90-day mortality 8 (10.1%) 6 (3.8%) 0.076
1 n (%)
2 Pearson's Chi-squared test; Fisher's exact test

Ambulation

Ambulatory status by day

Table 5: Ambulation
Characteristic Group p-value2
MAC-STILA, N = 791 General Anesthesia, N = 1581
Ambulated on POD1 37 (46.8%) 75 (48.1%) 0.857
Ambulated on POD2 53 (67.1%) 101 (63.9%) 0.630
Ambulated on POD3 54 (68.4%) 115 (72.8%) 0.477
Ambulated before discharge 60 (75.9%) 125 (79.1%) 0.579
Distance ambulated before discharge (feet) 20.6 +/- 27.8 27.2 +/- 43.8 0.228
Maximum distance ambulated (feet) 15.8 +/- 25.0 23.4 +/- 40.6 0.077
1 n (%); Mean +/- SD
2 Pearson's Chi-squared test; Welch Two Sample t-test

Ambulation by discharge

Table 6: Odds of ambulating by time of discharge
Characteristic OR1 95% CI1 p-value
Group
    General Anesthesia
    MAC-STILA 0.91 0.44, 1.89 0.788
ASA 0.71 0.40, 1.22 0.227
Baseline ambulatory status
    Community
    Household 0.62 0.31, 1.25 0.181
Baseline assistive device
    No
    Yes 0.15 0.02, 0.55 0.014
Preoperative dementia 0.19 0.09, 0.39 <0.001
1 OR = Odds Ratio, CI = Confidence Interval

Table: Multivariable logistic regression demonstrating that there is no difference in the odds of being able to ambulate by the time of discharge between groups.

AMS

Table 7: Odds of developing postoperative AMS
Characteristic OR1 95% CI1 p-value
Group
    General Anesthesia
    MAC-STILA 0.15 0.04, 0.46 0.003
ASA 1.46 0.70, 3.04 0.306
CCI 0.85 0.65, 1.11 0.250
Baseline ambulatory status
    Community
    Household 2.24 0.90, 5.71 0.084
Baseline assistive device
    No
    Yes 4.96 1.22, 26.4 0.039
Preoperative dementia 92.5 31.4, 357 <0.001
1 OR = Odds Ratio, CI = Confidence Interval

Table. Multivariable logistic regression demonstrating that patients in the MAC-STILA group were associated with significantly lower odds of postoperative (POD0-3) AMS compared to patients in the general anesthesia group.

Figure 1: Model coefficients for odds of developing postoperative AMS.