One-year Outcomes of Spinal versus General Anesthesia: Reply

We agree with Drs. Petersen, Braithwaite, and Torgeson1 that the CI values reported in our recent article provide valuable information to guide interpretation of our findings. As we state in thearticle, our results exclude large effects of anesthesia type on long-term outcomes but do not rule out more subtle effects.2We also agree with Petersen et al.1 that avoiding selective enrollment is important for ensuring the generalizability of pragmatic trials. Within Regional versus General Anesthesia for Promoting Independence after Hip Fracture (REGAIN), we took extensive efforts to limit selective enrollment through site auditing and feedback and completed an ancillary study to understand reasons underlying individual clinicians’ decisions to permit or decline randomization for a given patient.3 Ultimately, 6% of exclusions in REGAIN were due to clinician discretion.4 We are reassured by this low rate; however, because we did not collect detailed data on excluded patients from REGAIN, we cannot comment on the extent to which these exclusions may have affected the generalizability of our findings.Dr. Vail reports funding from eGenesis (Cambridge, Massachusetts) unrelated to the current project. The other authors declare no competing interests.