Outcomes with spinal versus general anesthesia for patients with and without preoperative cognitive impairment: Secondary analysis of a randomized clinical trial-Reference-Cited by-同舟云学术

Outcomes with spinal versus general anesthesia for patients with and without preoperative cognitive impairment: Secondary analysis of a randomized clinical trial

Published:2023-05-12 Issue:9 Volume:19 Page:4008-4019
ISSN:1552-5260
Container-title:Alzheimer's & Dementia
language:en
Short-container-title:Alzheimer's & Dementia

Author:

O'Brien Kyra¹,Feng Rui²³,Sieber Frederick⁴,Marcantonio Edward R.⁵,Tierney Ann³,Magaziner Jay⁶,Carson Jeffrey L.⁷,Dillane Derek⁸,Sessler Daniel I.⁹,Menio Diane¹⁰,Ayad Sabry⁹,Stone Trevor¹¹,Papp Steven¹²,Schwenk Eric S.¹³,Marshall Mitchell¹⁴,Jaffe J. Douglas¹⁵,Luke Charles¹⁶,Sharma Balram¹⁷,Azim Syed¹⁸,Hymes Robert¹⁹,Chin Ki‐Jinn²⁰,Sheppard Richard²¹,Perlman Barry²²,Sappenfield Joshua²³,Hauck Ellen²⁴,Hoeft Mark A.²⁵,Karlawish Jason²⁶,Mehta Samir²⁷,Donegan Derek J.²⁷,Horan Annamarie²⁷,Ellenberg Susan S.²³,Neuman Mark D.²⁶²⁸,

Affiliation:

1. Department of Neurology University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania USA

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

3. Center for Clinical Epidemiology and Biostatistics University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania USA

4. Department of Anesthesiology and Critical Care Medicine Johns Hopkins Medical Institutions Baltimore Maryland USA

5. Department of Medicine Beth Israel Deaconess Medical Center, and Harvard Medical School Boston Massachusetts USA

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

7. Division of General Internal Medicine Rutgers Robert Wood Johnson Medical School New Brunswick New Jersey USA

8. Department of Anesthesiology and Pain Medicine University of Alberta Edmonton Canada

9. Department of Outcomes Research Cleveland Clinic Cleveland Ohio USA

10. Center for Advocacy for the Rights and Interests of the Elderly Philadelphia Pennsylvania USA

11. Department of Orthopaedics University of British Columbia Vancouver Canada

12. Division of Orthopaedics Ottawa Hospital Civic Campus Ottawa Canada

13. Department of Anesthesiology Sidney Kimmel Medical College at Thomas Jefferson University Philadelphia Pennsylvania USA

14. Department of Anesthesiology New York University Langone Medical Center New York New York USA

15. Department of Anesthesiology Wake Forest School of Medicine Winston‐Salem North Carolina USA

16. Department of Anesthesiology University of Pittsburgh Medical Center Pittsburgh Pennsylvania USA

17. Department of Anesthesiology Lahey Hospital and Medical Center Burlington Massachusetts USA

18. Department of Anesthesiology Stony Brook University Stony Brook New York USA

19. Department of Orthopedic Surgery Inova Fairfax Medical Campus Falls Church Virginia USA

20. Department of Anesthesiology and Pain Medicine University of Toronto Toronto Canada

21. Department of Anesthesiology Hartford Hospital Hartford Connecticut USA

22. Department of Internal Medicine Peacehealth Medical Group Springfield Oregon USA

23. Department of Anesthesiology University of Florida College of Medicine Gainesville Florida USA

24. Department of Anesthesiology Lewis Katz School of Medicine at Temple University Philadelphia Pennsylvania USA

25. Department of Anesthesiology University of Vermont Larner College of Medicine Burlington Vermont USA

26. Department of Internal Medicine, Division of Geriatric Medicine, Perelman School of Medicine University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania USA

27. Department of Orthopaedic Surgery, Perelman School of Medicine University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania USA

28. Department of Anesthesiology and Critical Care, Perelman School of Medicine University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania USA

Abstract

AbstractINTRODUCTIONThe effect of spinal versus general anesthesia on the risk of postoperative delirium or other outcomes for patients with or without cognitive impairment (including dementia) is unknown.METHODSPost hoc secondary analysis of a multicenter pragmatic trial comparing spinal versus general anesthesia for adults aged 50 years or older undergoing hip fracture surgery.RESULTSAmong patients randomized to spinal versus general anesthesia, new or worsened delirium occurred in 100/295 (33.9%) versus 107/283 (37.8%; odds ratio [OR] 0.85; 95% confidence interval [CI] 0.60 to 1.19) among persons with cognitive impairment and 70/432 (16.2%) versus 71/445 (16.0%) among persons without cognitive impairment (OR 1.02; 95% CI 0.71 to 1.47, p = 0.46 for interaction). Delirium severity, in‐hospital complications, and 60‐day functional recovery did not differ by anesthesia type in patients with or without cognitive impairment.DISCUSSIONAnesthesia type is not associated with differences in delirium and functional outcomes among persons with or without cognitive impairment.

Publisher

Wiley

Subject

Psychiatry and Mental health,Cellular and Molecular Neuroscience,Geriatrics and Gerontology,Neurology (clinical),Developmental Neuroscience,Health Policy,Epidemiology

Reference40 articles.

1. Postoperative Delirium in Older Patients: A Systematic Review of Assessment and Incidence of Postoperative Delirium

2. Recent Advances in Preventing and Managing Postoperative Delirium

3. Effect of Delirium and Other Major Complications on Outcomes After Elective Surgery in Older Adults

4. Delirium is a risk factor for further cognitive decline in cognitively impaired hip fracture patients