Your next patient is a 75-year-old woman who fell while walking across her living room and sustained a right hip fracture. You plan to place a spinal anesthetic for the hip fracture repair surgery. According to a recent study, which of the following outcomes is MOST likely improved 60 days after surgery in patients receiving spinal versus general anesthesia?
- □ (A) Mortality
- □ (B) Ability to ambulate
- □ (C) Neither
Hip fractures occur in more than 300,000 older adults per year in the United States, and almost all require surgical correction. General and spinal anesthesia are the two most common anesthetic techniques for operative anesthesia. Definitive evidence is lacking as to which option results in better outcomes, but observational studies have favored spinal anesthesia. A recent large, international study was conducted to provide a definitive answer to this question.
“This well-conducted, large, pragmatic, randomized controlled trial provides the most definitive evidence to date that the type of anesthetic technique – spinal versus general anesthesia – for hip fracture surgery does not appreciably affect outcomes.”
A total of 1,600 patients from 46 hospitals in the U.S. and Canada were enrolled in this randomized controlled trial. Patients at least 50 years of age who were previously able to ambulate across a room without assistance and scheduled for surgical repair of a hip fracture were randomized to spinal or general anesthesia. Other components of care were left to the discretion of the anesthesia teams in this pragmatic study. The primary composite outcome was death or inability to ambulate at 60 days after surgery. Secondary outcomes included 60-day mortality, inability to ambulate at 60 days, and new-onset delirium. Exploratory outcomes included medical complications, time to first ambulation, discharge disposition, residential location at 60 days, and functional status at 60 days.
Patient characteristics were similar between the spinal (n=795) and general (n=805) anesthesia groups. In the intention-to-treat analysis of the primary composite outcome (death or inability to ambulate 60 days after surgery), there was no difference between groups (relative risk [RR], 1.03; 95% CI, 0.84-1.27). Similarly, there were no differences found in the secondary outcomes: inability to ambulate 60 days after surgery (RR, 1.06; 95% CI, 0.82-1.36), 60-day mortality (RR, 0.97; 95% CI, 0.59-1.57), and new-onset delirium (RR, 1.04; 95% CI, 0.84-1.30).
In conclusion, this well-conducted, large, pragmatic, randomized controlled trial provides the most definitive evidence to date that the type of anesthetic technique – spinal versus general anesthesia – for hip fracture surgery does not appreciably affect outcomes.
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