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ASA: Spinal Anesthesia Not Superior for Hip Fracture Surgery

Composite outcome of survival and recovery of ambulation at 60 days similar with spinal anesthesia, general anesthesia in older adults

older man walking with a walker and younger man by his side
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WEDNESDAY, Oct. 13, 2021 (HealthDay News) -- For older adults undergoing surgery for hip fracture, survival and recovery of ambulation at 60 days do not differ significantly with use of spinal versus general anesthesia, according to a study published online Oct. 9 in the New England Journal of Medicine to coincide with the annual meeting of the American Society of Anesthesiologists, held from Oct. 8 to 12 in San Diego.

Mark D. Neuman, M.D., from the University of Pennsylvania Perelman School of Medicine in Philadelphia, and colleagues conducted a randomized, superiority trial to compare spinal anesthesia (795 patients) to general anesthesia (805 patients) in previously ambulatory patients aged 50 years and older who were undergoing surgery for hip fracture.

The researchers found that the composite primary outcome of death or an inability to walk about 3 m independently or with a walker or cane at 60 days after randomization occurred in 18.5 and 18.0 percent, respectively, of 712 patients in the spinal anesthesia group and 733 in the general anesthesia group in the modified intention-to-treat population for whom data were available (relative risk, 1.03; 95 percent confidence interval, 0.84 to 1.27; P = 0.83). There were also no significant between-group differences observed in an inability to walk independently at 60 days and death within 60 days. Delirium occurred in 20.5 and 19.7 percent of patients in the spinal and general anesthesia groups, respectively (relative risk, 1.04; 95 percent confidence interval, 0.84 to 1.30).

"Our finding of similar outcomes at 60 days with either technique suggests that anesthesia choices for hip-fracture surgery may be based on patient preference rather than on anticipated differences in clinical outcomes," the authors write.

Two authors disclosed financial ties to the biopharmaceutical industry.

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