No difference found between spinal and general anesthesia for individuals undergoing hip fracture surgery

Hip fractures are devastating injuries and remain one of the largest healthcare challenges. The incidence increases with advancing age. Therefore, patients need to undergo surgery, requiring anesthesia to be performed so that surgery is safe and not painful.

Nearly all patients will receive either spinal or general anesthesia. While previous studies have attempted to determine how the type of anesthesia might influence the outcome, until now, studies have remained inconclusive.

A new study by the University of Bristol determined spinal anesthesia’s clinical effectiveness and safety compared with general anesthesia in patients undergoing hip fracture surgery. For this, scientists used a recently developed core outcome set and outcomes highlighted as necessary by patients in previous initiatives.

They performed a meta-analysis on the findings of 15 hip fracture Randomized Controlled Trials (RCTs) using modern anesthetic techniques, published between 2003 and 2022. This involved 3,866 patients, all of whom had undergone hip fracture surgery under either a spinal or general anesthetic. The patients’ ages ranged from 66 to 86.

The scientists found that there were no differences between spinal and general anesthesia in patients undergoing hip fracture surgery in terms of mortality, acute coronary syndrome, hypotension, acute kidney injury, delirium, pneumonia, orthogeriatric input, being out of bed on day one following surgery, pain, and significant patient-defined outcomes—with the exception of acute kidney injury.

Mr. Gulraj Matharu, the study’s senior author, and a Clinical Lecturer at the University of Bristol’s Bristol Medical School, said: “Our findings suggest no difference in outcomes for patients with either spinal or general anesthesia for hip fracture surgery. The clinical decision to use a particular anesthetic is a complex process. It should be based on the patient’s risk profile and preference, as well as the expertise of the anaesthetist. Our findings are therefore reassuring for clinicians who can continue to use either type of anesthetic at this time.”

“However, the evidence we assessed ranged from high to very low-quality studies. Furthermore, most studies only reported one to three outcomes from the recently devised core outcome set, and only a few studies reported on any outcomes that were considered important to patients.”

“This is something that can be improved on when designing future research studies in this area. Therefore we feel that outcomes which are specifically important to patients (including pre-operative residence, quality of life, and mobility status) should be incorporated into future trials comparing anesthetic techniques in patients undergoing hip fracture surgery.”

Journal Reference:

1. S Kunutsor et al. Clinical effectiveness and safety of spinal anesthesia compared with general anesthesia in patients undergoing hip fracture surgery using a consensus-based core outcome set and patient and public informed outcomes: A systematic review and meta analysis of contemporary randomised controlled trials. British Journal of Anaesthesia. DOI: 10.1016/j.bja.2022.07.031