Long-term Outcomes with Spinal <i>versus</i> General Anesthesia for Hip Fracture Surgery: A Randomized Trial-Reference-Cited by-同舟云学术

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

Published:2024-01-05 Issue: Volume: Page:
ISSN:0003-3022
Container-title:Anesthesiology
language:en
Short-container-title:

Author:

Vail Emily A.¹,Feng Rui²,Sieber Frederick³,Carson Jeffrey L.⁴,Ellenberg Susan S.⁵,Magaziner Jay⁶,Dillane Derek⁷,Marcantonio Edward R.⁸,Sessler Daniel I.⁹,Ayad Sabry¹⁰,Stone Trevor¹¹,Papp Steven¹²,Donegan Derek¹³,Mehta Samir¹⁴,Schwenk Eric S.¹⁵^ORCID,Marshall Mitchell¹⁶,Jaffe J. Douglas¹⁷,Luke Charles¹⁸,Sharma Balram¹⁹,Azim Syed²⁰,Hymes Robert²¹,Chin Ki-Jinn²²,Sheppard Richard²³,Perlman Barry²⁴,Sappenfield Joshua²⁵,Hauck Ellen²⁶,Tierney Ann²⁷,Horan Annamarie D.²⁸,Neuman Mark D.²⁹,

Affiliation:

1. 1Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania.

2. 2Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.

3. 3Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland.

4. 4Division of General Internal Medicine, Rutgers–Robert Wood Johnson Medical School, New Brunswick, New Jersey.

5. 5Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.

6. 6Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland.

7. 7Department of Anesthesiology and Pain Medicine, University of Alberta Hospital, Edmonton, Alberta, Canada.

8. 8Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.

9. 9Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio.

10. 10Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio.

11. 11Department of Orthopedics, University of British Columbia, Vancouver, British Columbia, Canada.

12. 12Division of Orthopedics, Ottawa Hospital Civic Campus, Ottawa, Ontario, Canada.

13. 13Department of Orthopedic Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.

14. 14Department of Orthopedic Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.

15. 15Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania.

16. 16Department of Anesthesiology, New York University Langone Medical Center, New York, New York.

17. 17Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina.

18. 18Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.

19. 19Department of Anesthesiology, Lahey Hospital and Medical Center, Burlington, Massachusetts.

20. 20Department of Anesthesiology, Stony Brook University, Stony Brook, New York.

21. 21Department of Orthopedic Surgery, Inova Fairfax Medical Campus, Falls Church, Virginia.

22. 22Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada.

23. 23Department of Anesthesiology, Hartford Hospital, Hartford, Connecticut.

24. 24Peacehealth Medical Group, Springfield, Oregon.

25. 25Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida.

26. 26Department of Anesthesiology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania.

27. 27Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.

28. 28Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania.

29. 29Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania.

Abstract

Background The effects of spinal versus general anesthesia on long-term outcomes have not been well studied. This study tested the hypothesis that spinal anesthesia is associated with better long-term survival and functional recovery than general anesthesia. Methods A prespecified analysis was conducted of long-term outcomes of a completed randomized superiority trial that compared spinal anesthesia versus general anesthesia for hip fracture repair. Participants included previously ambulatory patients 50 yr of age or older at 46 U.S. and Canadian hospitals. Patients were randomized 1:1 to spinal or general anesthesia, stratified by sex, fracture type, and study site. Outcome assessors and investigators involved in the data analysis were masked to the treatment arm. Outcomes included survival at up to 365 days after randomization (primary); recovery of ambulation among 365-day survivors; and composite endpoints for death or new inability to ambulate and death or new nursing home residence at 365 days. Patients were included in the analysis as randomized. Results A total of 1,600 patients were enrolled between February 12, 2016, and February 18, 2021; 795 were assigned to spinal anesthesia, and 805 were assigned to general anesthesia. Among 1,599 patients who underwent surgery, vital status information at or beyond the final study interview (conducted at approximately 365 days after randomization) was available for 1,427 (89.2%). Survival did not differ by treatment arm; at 365 days after randomization, there were 98 deaths in patients assigned to spinal anesthesia versus 92 deaths in patients assigned to general anesthesia (hazard ratio, 1.08; 95% CI, 0.81 to 1.44, P = 0.59). Recovery of ambulation among patients who survived a year did not differ by type of anesthesia (adjusted odds ratio for spinal vs. general, 0.87; 95% CI, 0.67 to 1.14; P = 0.31). Other outcomes did not differ by treatment arm. Conclusions Long-term outcomes were similar with spinal versus general anesthesia. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Anesthesiology and Pain Medicine

Link

https://pubs.asahq.org/anesthesiology/article-pdf/doi/10.1097/ALN.0000000000004807/699755/aln.0000000000004807.pdf

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