Association of perioperative etomidate exposure and mortality after hip fracture surgery: a matched cohort study

Abstract

Etomidate is often used for anesthetic induction in hemodynamically unstable patients because of its cardiovascular stability, but its transient adrenal suppression raises concern about possible adverse postoperative outcomes. We performed a cohort study using the TriNetX Research Network to examine the association between perioperative etomidate exposure and postoperative outcomes in adults undergoing hip fracture surgery. Patients receiving etomidate were matched 1:1 with controls. The primary outcome was 30-day mortality. Secondary outcomes included pneumonia, sepsis, venous thromboembolism, major adverse cardiovascular events (MACEs), and acute kidney injury (AKI). After matching, 6,246 patients were included in each group with balanced baseline characteristics. Etomidate exposure was associated with higher risks of 30-day mortality (OR 1.35, 95% CI 1.15–1.60; P < 0.001), pneumonia (OR 1.23, 95% CI 1.03–1.47, P = 0.019), and MACEs (OR 1.20, 95% CI 1.04–1.40, P = 0.014), but a lower risk of AKI (OR 0.83, 95% CI 0.71–0.96, P = 0.014). No significant associations were observed for sepsis or venous thromboembolism. All associations attenuated and became non-significant during extended follow-up (30–180 day). In conclusion, perioperative etomidate exposure was associated with worse short-term postoperative outcomes except for a lower AKI risk. These findings warrant prospective confirmation.