Spinal anesthesia no better than general anesthesia for hip fracture surgery in older adults: NEJM
USA: Spinal anesthesia is not superior to general anesthesia for hip fracture surgery in older adults, a recent study noted. This was with regards to survival and recovery of ambulation at 60 days. Also, the incidence of postoperative delirium was found to be similar in the two types of anesthesia. The study appears in the New England Journal of Medicine.
The effects of spinal anesthesia versus general anesthesia in older adults undergoing surgery for hip fracture, on the ability to walk have not been well studied. Mark D Neuman and the team, therefore, 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 ratio of 1:1 to receive spinal (n=795) or general anesthesia (n=805). The mean age was 78 years; 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.
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 were death within 60 days, delirium, time to discharge, and ambulation at 60 days.
Key findings include:
- 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).
- 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), and death within 60 days occurred in 30 of 768 (3.9%) and 32 of 784 (4.1%), respectively (relative risk, 0.97).
- 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).
"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," wrote the authors. "The incidence of postoperative delirium was similar with the two types of anesthesia."
Reference:
Neuman MD, Feng R, Carson JL, Gaskins LJ, Dillane D, Sessler DI, Sieber F, Magaziner J, Marcantonio ER, Mehta S, Menio D, Ayad S, Stone T, Papp S, Schwenk ES, Elkassabany N, Marshall M, Jaffe JD, Luke C, Sharma B, Azim S, Hymes RA, Chin KJ, Sheppard R, Perlman B, Sappenfield J, Hauck E, Hoeft MA, Giska M, Ranganath Y, Tedore T, Choi S, Li J, Kwofie MK, Nader A, Sanders RD, Allen BFS, Vlassakov K, Kates S, Fleisher LA, Dattilo J, Tierney A, Stephens-Shields AJ, Ellenberg SS; REGAIN Investigators. Spinal Anesthesia or General Anesthesia for Hip Surgery in Older Adults. N Engl J Med. 2021 Nov 25;385(22):2025-2035. doi: 10.1056/NEJMoa2113514. Epub 2021 Oct 9. PMID: 34623788.
