Mode of anaesthesia for hip fracture surgery: is it time to put the question to sleep?

Whether spinal or general anaesthesia offers advantages to patients with hip fracture or to the health-care services providing hip fracture surgery has long been debated. Well conducted observational studies have generally found either no difference or small benefits in favour of spinal anaesthesia.1 Randomised controlled trials (RCTs) have consistently found no differences in outcomes.2–4 Published in The Lancet Healthy Longevity, the Improve Hip Fracture Outcome in the Elderly Patient (iHOPE) trial by Ana Kowark and colleagues5 adds to this body of evidence.