Spinal, general anesthesia in hip fracture surgery show similar survival, ambulation rates
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Published results showed rate of survival and recovery of ambulation at 60 days did not differ between use of spinal or general anesthesia among patients undergoing hip fracture surgery.
Mark D. Neuman, MD, MSc, associate professor of anesthesiology and critical care at the Perelman School of Medicine at the University of Pennsylvania, and colleagues randomly assigned 1,600 patients aged 50 years and older undergoing hip fracture surgery to receive either spinal (n = 795) or general (n = 805) anesthesia at 46 hospitals in the United States and Canada. Researchers considered a composite of death or inability to walk approximately 10 feet independently or with a walker or cane 60 days after randomization as the primary outcome, while 60-day mortality, delirium, time to discharge and ambulation among individuals who survived 60-days were considered secondary outcomes.
Results showed 83.8% (n = 666) and 95.5% (n = 769) of patients ultimately received their assigned spinal and general anesthesia, respectively. Researchers found 18.5% of patients in the spinal anesthesia group and 18% of patients in the general anesthesia group experienced the composite primary outcome (RR = 1.03; 95% CI, 0.84-1.27). Patients in the spinal and general anesthesia groups showed similar results for an inability to walk independently at 60 days (15.2% vs. 14.4%), death within 60 days (3.9% vs. 4.1%) and delirium (20.5% vs. 19.7%). Although low, researchers found a difference in rates of death during hospitalization, acute kidney injury and need for postoperative critical care admission between the two groups.
“For most patients with hip fracture, either general or spinal anesthesia is likely to be a safe choice. Our study gives orthopedic surgeons and anesthesiologists concrete information they can use to help patients and families make informed decisions about their care,” Neuman, who also serves as the director of the Penn Center for Perioperative Outcomes Research and Transformation at the Perelman School of Medicine, told Healio Orthopedics.
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