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Randomized Controlled Trial

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

Emily A Vail et al. Anesthesiology. .

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.

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Conflict of interest statement

Conflicts of Interest: Emily Vail reports receipt of funding from the Agency for Healthcare Research and Quality and Transplant Foundation (Philadelphia, Pennsylvania) via competitive research grants. Susan Ellenberg reports funding from AbbVie outside the submitted work. Jay Magaziner reports consulting fees from Novartis, UCB, and Pluristem outside the submitted work, and service on Boards for the Own the Bone Program of the American Orthopedic Association and Fragility Fracture Network. Derek Dillane reports personal fees from the American Society of Regional Anesthesia and personal fees from Springer Nature, all outside the submitted work. Derek Donegan reports consulting fees from Depuy Synthes and stock options/intellectual property from ORTelligence outside the submitted work. Eric Schwenk reports receiving royalties from Up To Date. J. Douglas Jaffe has received payments from Konica Minolta Inc and Pacira life sciences. The other authors have no conflicts to disclose.

Figures

Appendix Figure 1.
Appendix Figure 1.
CONSORT diagram
Figure 1.
Figure 1.. Kaplan-Meier plot of days to death censored at 365 days
Shading represents 95% confidence limits (CI). Log-rank P=0.59. Hazard ratio from the Cox model adjusting for age group, fracture type, and country of randomization: 1.08 (95% CI 0.81, 1.44), P=0.59.
Figure 2.
Figure 2.. Unadjusted ambulation and survival outcomes at approximately 60, 180, and 365 days after randomization, stratified by treatment group
60-day interview data were available for 712 patients in the spinal anesthesia group and 732 patients in the general anesthesia group; 180-day interview data were available for 694 patients in the spinal anesthesia group and 707 in the general anesthesia group. 365-day interview data were available for 684 patients in the spinal anesthesia group and 676 in the general anesthesia group.
See this image and copyright information in PMC

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