Comparison of general anesthesia and spinal anesthesia in patients with moderate to severe aortic stenosis undergoing surgery for hip fracture: a retrospective cohort study

Q: What are the key findings of this study?

Spinal anesthesia significantly reduced intraoperative hypotension (MAP <65 mmHg AUT) compared to general anesthesia (β = -260 mmHg·min; p = 0.019) in moderate-to-severe aortic stenosis patients.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Moderate to severe aortic stenosis undergoing hip fracture surgery (n=103). Intervention: Spinal anesthesia vs. General anesthesia. Primary outcome: Intraoperative hypotension quantified as the area under the threshold (AUT) for mean arterial pressure below 65 mmHg (mmHg·min) (MD -270 mmHg·min (adjusted β = -260 mmHg·min), 95% CI -490 to -71, p=< 0.01).

Q: What does this research mean for the field?

In patients with moderate to severe aortic stenosis undergoing hip fracture surgery, spinal anesthesia significantly reduces intraoperative hypotension and vasopressor requirements compared with general anesthesia without increasing 30-day mortality or postoperative complications. Novelty: ClaimNovelty.CONTRADICTORY. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

Q: What question did this study set out to answer?

To compare intraoperative hypotension and postoperative outcomes between spinal anesthesia and general anesthesia in patients with moderate to severe aortic stenosis undergoing hip fracture surgery.

Tomoyo Ando; Nobuko Fujita; Yuki Yonekura; K Miyasaka; Seiki Abe

doi:10.1186/s13019-026-04766-7

October 31, 2026Journal of Cardiothoracic SurgeryOpen Access

Comparison of general anesthesia and spinal anesthesia in patients with moderate to severe aortic stenosis undergoing surgery for hip fracture: a retrospective cohort study

View Full Paper

Ask AI

Bookmark

Share

Key result

Spinal anesthesia is linked to significantly less intraoperative hypotension than general anesthesia in aortic stenosis.

MD -270 mmHg·min (adjusted β = -260 mmHg·min)
95% CI -490 to -71
P<0.01
n=103

Why the study?

Data comparing spinal and general anesthesia in patients with moderate to severe aortic stenosis undergoing hip fracture surgery are limited, and clear evidence supporting the historical relative contraindication of spinal anesthesia in aortic stenosis is lacking.

Does spinal anesthesia reduce intraoperative hypotension and perioperative complications compared to general anesthesia in patients with moderate to severe aortic stenosis undergoing hip fracture surgery?

Key Points

To compare intraoperative hypotension and postoperative outcomes between spinal anesthesia and general anesthesia in patients with moderate to severe aortic stenosis undergoing hip fracture surgery.
Single-center retrospective observational study of 103 patients with moderate to severe aortic stenosis undergoing hip fracture surgery.
Patients were grouped by anesthetic technique: general anesthesia (n = 76) or spinal anesthesia (n = 27), with the majority in the spinal group receiving isobaric 0.5% bupivacaine.
The primary outcome was intraoperative hypotension, measured as the area under the threshold for mean arterial pressure below 65 mmHg.
Spinal anesthesia was associated with a lower area under the threshold for mean arterial pressure below 65 mmHg (β = -260 mmHg·min, 95% CI, -470 to -43; p = 0.019) and a smaller hypotension ratio (β = -9.8%, 95% CI, -20 to -0.042; p = 0.049).
Phenylephrine requirements were significantly lower in the spinal anesthesia group compared to general anesthesia (β = -1.6 mg, 95% CI, -2.3 to -0.96; p < 0.01).
No statistically significant differences occurred between groups for 30-day mortality (OR 0.52, 95% CI, 0.033 to 8.1; p = 0.64), acute kidney injury (OR 1.2, 95% CI, 0.46 to 3.4; p = 0.68), delirium (OR 0.48, 95% CI, 0.19 to 1.2; p = 0.13), or heart failure (OR 1.4, 95% CI, 0.41 to 4.7; p = 0.59).

Study Design

Type

Cohort (n=103)

Multicenter

No

Structured PICO

Does spinal anesthesia reduce intraoperative hypotension and perioperative complications compared to general anesthesia in patients with moderate to severe aortic stenosis undergoing hip fracture surgery?

P

Population

103 patients in Japan with moderate to severe aortic stenosis undergoing hip fracture surgery under spinal or general anesthesia, followed for 30 days.

E

Exposure

Spinal anesthesia (mostly isobaric 0.5% bupivacaine at the L3/4 interspace; mean intrathecal dose 2.8 ± 0.33 mL [14 ± 1.7 mg])

C

Comparator

General anesthesia

O

Outcome

Intraoperative hypotension, quantified as the area under the threshold (AUT in mmHg·minutes) representing the duration and magnitude of mean arterial pressure (MAP) below 65 mmHg between the start and end of anesthesiasurrogate

Main Result

Mean Difference: -270 (95% CI -490–-71)

Absolute Event Rate: 250% vs 520%

p-value: p=< 0.01

Contrary to historical assumptions that spinal anesthesia is contraindicated in aortic stenosis, spinal anesthesia significantly reduced intraoperative hypotension and vasopressor requirements compared with general anesthesia during hip fracture surgery without increasing 30-day mortality or complications.

Limitations

Retrospective single-center design may limit generalizability
Relatively small sample size, particularly in the spinal anesthesia group (n=27), reducing statistical power for rare outcomes like mortality
Study population consisted exclusively of Asian patients with relatively low BMI, limiting generalizability to other ethnic populations
Retrospective single-center design may limit the generalizability of results
Relatively small sample size, particularly in the spinal anesthesia group (n=27), which may have reduced statistical power to detect differences in rare outcomes such as mortality

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

Spinal anesthesia was associated with less hypotension in aortic stenosis hip fracture surgery; challenges historical contraindication but leaves open randomized confirmation.

Abstract

Background: Patients with moderate to severe aortic stenosis undergoing hip fracture surgery are at high risk for perioperative complications, but data comparing spinal anesthesia and general anesthesia are limited. Historically, spinal anesthesia has been considered relatively contraindicated in patients with aortic stenosis, but there is no clear evidence supporting this assumption. Methods: We conducted a single-center retrospective observational study of patients with moderate to severe aortic stenosis undergoing hip fracture surgery. Patients were classified by anesthetic technique (general anesthesia or spinal anesthesia). The primary outcome was intraoperative hypotension, quantified as the area under the threshold, representing the duration and magnitude of mean arterial pressure below 65 mmHg. Secondary outcomes included the ratio of hypotensive time to total anesthesia time, vasopressor requirements, 30-day mortality, postoperative complications, time to first analgesic request, and numeric rating scale pain scores postoperatively. Results: Among 103 patients analyzed (general anesthesia = 76; spinal anesthesia = 27), baseline characteristics were comparable between groups. Spinal anesthesia was associated with lower area under the threshold for mean arterial pressure below 65 mmHg (β = -260 mmHg·min, 95% CI, -470 to -43; p = 0.019), smaller hypotension ratio (β = -9.8%, 95% CI, -20 to -0.042; p = 0.049), and reduced phenylephrine use (β = -1.6 mg, 95% CI, -2.3 to -0.96; p < 0.01). There were no statistical differences between groups in mortality and postoperative complications (30-day mortality: OR 0.52, 95% CI, 0.033 to 8.1; p = 0.64; acute kidney injury: OR 1.2, 95% CI, 0.46 to 3.4, p = 0.68; delirium: OR 0.48, 95% CI, 0.19 to 1.2; p = 0.13; heart failure: OR 1.4, 95% CI, 0.41 to 4.7; p = 0.59). Conclusions: In patients with moderate to severe aortic stenosis undergoing hip fracture surgery, spinal anesthesia significantly reduced intraoperative hypotension and vasopressor use, compared with general anesthesia. These findings suggest that spinal anesthesia may be a safe and practical alternative to general anesthesia in patients with moderate to severe aortic stenosis.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Ando et al. (2026) conducted a cohort in Moderate to severe aortic stenosis undergoing hip fracture surgery (n=103). Spinal anesthesia vs. General anesthesia was evaluated on Intraoperative hypotension quantified as the area under the threshold (AUT) for mean arterial pressure below 65 mmHg (mmHg·min) (MD -270 mmHg·min (adjusted β = -260 mmHg·min), 95% CI -490 to -71, p=< 0.01). Spinal anesthesia significantly reduced intraoperative hypotension (MAP <65 mmHg AUT) compared to general anesthesia (β = -260 mmHg·min; p = 0.019) in moderate-to-severe aortic stenosis patients.

synapsesocial.com/papers/6ae92596a8a6b2adf62f5fb6 https://doi.org/10.1186/s13019-026-04766-7

View Full Paper

Ask AI

Bookmark

Share

Comparison of general anesthesia and spinal anesthesia in patients with moderate to severe aortic stenosis undergoing surgery for hip fracture: a retrospective cohort study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Comparison of general anesthesia and spinal anesthesia in patients with moderate to severe aortic stenosis undergoing surgery for hip fracture: a retrospective cohort study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading