Long-term Outcomes with Spinal versus General Anesthesia for Hip Fracture Surgery: A Randomized Trial.

Area of Science:

• Anesthesiology
• Geriatric Medicine
• Orthopedic Surgery

Background:

• Long-term outcomes of spinal versus general anesthesia are not well-established.
• Hip fracture repair is a common procedure in elderly patients.

Purpose of the Study:

• To test the hypothesis that spinal anesthesia leads to better long-term survival and functional recovery compared to general anesthesia.
• To evaluate the impact of anesthesia type on mortality and ambulation post-hip fracture surgery.

Main Methods:

• A randomized superiority trial compared spinal anesthesia to general anesthesia for hip fracture repair in patients aged 50 years and older.
• The study analyzed long-term outcomes including survival at 365 days, recovery of ambulation, and composite endpoints.
• 1,600 patients were enrolled across 46 hospitals, with outcomes assessed by masked investigators.

Main Results:

• Survival at 365 days did not differ significantly between spinal (98 deaths) and general anesthesia (92 deaths) groups (HR, 1.08; P = 0.59).
• Recovery of ambulation among 365-day survivors was also similar between the two anesthesia groups (aOR, 0.87; P = 0.31).
• No significant differences were observed in composite endpoints for death or new inability to ambulate or move to a nursing home.

Conclusions:

• Long-term outcomes, including survival and functional recovery, were similar for patients undergoing hip fracture repair with spinal versus general anesthesia.
• The choice between spinal and general anesthesia for hip fracture repair may not significantly impact long-term patient outcomes.