Neuraxial Anesthesia Vs General Anesthesia for Hip Fracture: Outcomes in Elderly, Ortho Center

Background: Hip fractures in elderly patients are associated with high postoperative morbidity, prolonged hospitalization, functional decline, and early mortality. The anesthetic technique used during surgery may influence perioperative stability, postoperative complications, pain control, and recovery outcomes. Objective: To compare postoperative outcomes between neuraxial anesthesia and general anesthesia in elderly patients undergoing hip fracture surgery and to identify predictors of postoperative complications and 30-day mortality. Methods: This comparative observational study included 300 patients aged 65 years and above undergoing hip fracture surgery. Patients were categorized according to anesthetic technique into neuraxial anesthesia (n=156) and general anesthesia (n=144) groups. Baseline characteristics, intraoperative variables, postoperative complications, pain severity, hospital stay, patient satisfaction, ICU admission, and 30-day mortality were analyzed. Chi-square testing and multivariable logistic regression were performed. Results: Postoperative delirium was lower with neuraxial anesthesia than general anesthesia (12.8% vs 26.4%; p=0.004), as were pulmonary complications (10.3% vs 23.6%; p=0.003), severe pain at 24 hours (12.8% vs 23.6%; p=0.001), ICU admission (11.5% vs 23.6%; p=0.008), and 30-day mortality (3.8% vs 9.7%; p=0.047). General anesthesia was independently associated with postoperative complications (adjusted OR 2.14, 95% CI 1.28–3.56; p=0.004) and 30-day mortality (adjusted OR 2.62, 95% CI 1.01–6.78; p=0.047). Conclusion: Neuraxial anesthesia was associated with more favorable postoperative outcomes than general anesthesia among elderly hip fracture patients, although anesthetic selection should remain individualized because of the observational study design