Spinal Anesthesia or General Anesthesia for Hip Surgery in Older Adults

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.

Wu’s Take: This landmark study of 1600 patients in 46 hospitals in the US and Canada were randomized 1:1 to spinal or general anesthesia for hip arthroplasty. The two techniques were similar with respect to the outcomes of survival, ambulation at 30 days, and postoperative delirium. This will likely prompt a discussion with your high volume joint surgeons and about the best way to optimize throughput.