Key result
Spinal anesthesia did not confer a mortality benefit, a reduction in delirium, or a greater proportion of ambulation at 60 days compared to general anesthesia for hip fracture surgery.
Why the study?
Does spinal anesthesia improve mortality, delirium, or ambulation at 60 days compared to general anesthesia in patients with hip fractures?
Does spinal anesthesia improve mortality, delirium, or ambulation at 60 days compared to general anesthesia in patients with hip fractures?
General anesthesia is an acceptable and equally safe choice compared to spinal anesthesia for hip fracture surgery, challenging the notion that spinal anesthesia is inherently safer.
The debate over the optimal type of anesthesia for hip fracture surgery continues to rage. While retrospective evidence in elective total joint arthroplasty has suggested a reduction in complications with neuraxial anesthesia, previous retrospective studies in the hip fracture population have been mixed. Recently, two multicenter randomized, controlled trials (REGAIN and RAGA) have been published that examined delirium, ambulation at 60 days, and mortality in patients with hip fractures who were randomized to spinal or general anesthesia. These trials enrolled a combined 2,550 patients and found that spinal anesthesia did not confer a mortality benefit nor a reduction in delirium or greater proportion who could ambulate at 60 days. While these trials were not perfect, they call into question the practice of telling patients that spinal anesthesia is a "safer" choice for their hip fracture surgery. We believe a risk/benefit discussion should take place with each patient and that ultimately the patient should choose his or her anesthesia type after being informed of the state of the evidence. General anesthesia is an acceptable choice for hip fracture surgery.
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Schwenk et al. (2023) conducted an editorial in Hip fracture (n=2,550). Spinal anesthesia vs. General anesthesia was evaluated on Delirium, ambulation at 60 days, and mortality. Spinal anesthesia did not confer a mortality benefit, a reduction in delirium, or a greater proportion of ambulation at 60 days compared to general anesthesia for hip fracture surgery.
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