Regional versus general anesthesia in older patients for hip fracture surgery: a systematic review and meta-analysis of randomized controlled trials

Abstract

Background The optimal anesthesia technique for older patients undergoing hip fracture surgery remains controversial. We performed a systematic review and meta-analysis of updated randomized controlled trials (RCTs) to assess whether regional anesthesia was superior to general anesthesia in hip fracture surgery. Methods We searched PubMed, EMBASE, Web of Science, and the Cochrane Central Register of Controlled Trials from January 2000 until April 2022. RCTs directly comparing regional and general anesthesia in hip fracture surgery were included in the analysis. The incidence of delirium and mortality were the primary outcomes and other perioperative outcomes including complications were secondary outcomes. Results Thirteen studies involving 3736 patients were included in this study. There was no significant difference in the incidence of delirium (odds ratio [OR] 1.09; 95% confidence interval [CI] 0.86, 1.37) and mortality (OR 1.08; 95% CI 0.71, 1.64) between the two groups. Patients receiving regional anesthesia in hip fracture surgery were associated with a reduction in operative time (weighted mean difference [WMD]: − 4.74; 95% CI − 8.85, − 0.63), intraoperative blood loss (WMD: − 0.25; 95% CI − 0.37, − 0.12), postoperative pain score (WMD: − 1.77; 95% CI − 2.79, − 0.74), length of stay (WMD: − 0.10; 95% CI − 0.18, − 0.02), and risk of acute kidney injury (AKI) (OR 0.56; 95% CI 0.36, 0.87). No significant difference was observed in the other perioperative outcomes. Conclusions For older patients undergoing hip fracture surgery, RA did not significantly reduce the incidence of postoperative delirium and mortality compared to GA. Due to the limitations of this study, the evidence on delirium and mortality was still inconclusive and further high-quality studies are needed.

Effects of general and spinal anesthesia on postoperative rehabilitation in older adults after lower limb surgery: a retrospective cohort study

“…And reducing postoperative complications and hospitalization time are important indicators for accelerating postoperative rehabilitation. There are studies have reported that SA may be associated with a reduced incidence of postoperative complications, including death, deep vein thrombosis, pulmonary complications, and myocardial infarction (2,3,12,15,18), which aligns with our results. Selection bias is an obvious limitation of observational studies, resulting in unreliable results if improperly addressed.…”

“…The choice of anesthesia affects patients' intraoperative hemodynamics and cardiopulmonary function, affecting their prognosis. Therefore, anesthesia has been controversial for older patients with lower limb fractures (2)(3)(4)(5)(6)(7)(8), but how anesthesia affects postoperative rehabilitation remains unknown.…”