Spinal Anesthesia or General Anesthesia for Hip Surgery in Older Adults
- PMID: 34623788
- DOI: 10.1056/NEJMoa2113514
Spinal Anesthesia or General Anesthesia for Hip Surgery in Older Adults
Abstract
Background: The effects of spinal anesthesia as compared with general anesthesia on the ability to walk in older adults undergoing surgery for hip fracture have not been well studied.
Methods: We conducted a pragmatic, randomized superiority trial to evaluate spinal anesthesia as compared with general anesthesia in previously ambulatory patients 50 years of age or older who were undergoing surgery for hip fracture at 46 U.S. and Canadian hospitals. Patients were randomly assigned in a 1:1 ratio to receive spinal or general anesthesia. The primary outcome was a composite of death or an inability to walk approximately 10 ft (3 m) independently or with a walker or cane at 60 days after randomization. Secondary outcomes included death within 60 days, delirium, time to discharge, and ambulation at 60 days.
Results: A total of 1600 patients were enrolled; 795 were assigned to receive spinal anesthesia and 805 to receive general anesthesia. The mean age was 78 years, and 67.0% of the patients were women. A total of 666 patients (83.8%) assigned to spinal anesthesia and 769 patients (95.5%) assigned to general anesthesia received their assigned anesthesia. Among patients in the modified intention-to-treat population for whom data were available, the composite primary outcome occurred in 132 of 712 patients (18.5%) in the spinal anesthesia group and 132 of 733 (18.0%) in the general anesthesia group (relative risk, 1.03; 95% confidence interval [CI], 0.84 to 1.27; P = 0.83). An inability to walk independently at 60 days was reported in 104 of 684 patients (15.2%) and 101 of 702 patients (14.4%), respectively (relative risk, 1.06; 95% CI, 0.82 to 1.36), and death within 60 days occurred in 30 of 768 (3.9%) and 32 of 784 (4.1%), respectively (relative risk, 0.97; 95% CI, 0.59 to 1.57). Delirium occurred in 130 of 633 patients (20.5%) in the spinal anesthesia group and in 124 of 629 (19.7%) in the general anesthesia group (relative risk, 1.04; 95% CI, 0.84 to 1.30).
Conclusions: Spinal anesthesia for hip-fracture surgery in older adults was not superior to general anesthesia with respect to survival and recovery of ambulation at 60 days. The incidence of postoperative delirium was similar with the two types of anesthesia. (Funded by the Patient-Centered Outcomes Research Institute; REGAIN ClinicalTrials.gov number, NCT02507505.).
Copyright © 2021 Massachusetts Medical Society.
Comment in
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Patient-Centered Outcomes after General and Spinal Anesthesia.N Engl J Med. 2021 Nov 25;385(22):2088-2089. doi: 10.1056/NEJMe2116017. N Engl J Med. 2021. PMID: 34818484 No abstract available.
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Spinal versus general anaesthesia for the elderly hip fractured patient: It is probably time to move on!Anaesth Crit Care Pain Med. 2022 Apr;41(2):101045. doi: 10.1016/j.accpm.2022.101045. Epub 2022 Feb 19. Anaesth Crit Care Pain Med. 2022. PMID: 35192948 No abstract available.
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Spinal vs. General Anesthesia for Hip-Fracture Surgery.N Engl J Med. 2022 Feb 24;386(8):801. doi: 10.1056/NEJMc2119756. N Engl J Med. 2022. PMID: 35196436 No abstract available.
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Spinal vs. General Anesthesia for Hip-Fracture Surgery.N Engl J Med. 2022 Feb 24;386(8):801. doi: 10.1056/NEJMc2119756. N Engl J Med. 2022. PMID: 35196437 No abstract available.
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Spinal vs. General Anesthesia for Hip-Fracture Surgery.N Engl J Med. 2022 Feb 24;386(8):801-802. doi: 10.1056/NEJMc2119756. N Engl J Med. 2022. PMID: 35196438 No abstract available.
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Spinal vs. General Anesthesia for Hip-Fracture Surgery.N Engl J Med. 2022 Feb 24;386(8):802. doi: 10.1056/NEJMc2119756. N Engl J Med. 2022. PMID: 35196439 No abstract available.
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[Is delirium independent from the anesthesia technique?-What REGAIN and RAGA teach us].Anaesthesist. 2022 May;71(5):400-402. doi: 10.1007/s00101-022-01104-z. Epub 2022 Feb 23. Anaesthesist. 2022. PMID: 35199183 Free PMC article. German. No abstract available.
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