Effect of different anesthetic modalities on postoperative delirium in elderly hip fractures: A meta-analysis

Abstract

Background: Previous findings on the effect of general versus spinal anesthesia on postoperative delirium in elderly people with hip fractures are somewhat controversial. This article included the latest randomized controlled study for meta-analysis to evaluate the effect of general anesthesia (GA) and spinal anesthesia (SA) on delirium after hip fracture surgery in the elderly, so as to guide the clinical.

Methods: Cochrane Library, PubMed, Web Of Science, and Embase were searched from inception up to January 16, 2024. Randomized controlled trial (RCT) was included to evaluate the postoperative results of GA and SA in elderly patients (≥50 years old) undergoing hip fracture surgery. Two researchers independently screened for inclusion in the study and extracted data. Heterogeneity was assessed by the I²and Chi-square tests, and P < .1 or I² ≥ 50% indicated marked heterogeneity among studies. The Mantel-Haenszel method was used to estimate the combined relative risk ratio (RR) and the corresponding 95% confidence interval (CI) for the binary variables.

Results: Nine randomized controlled trials were included. There was no significant difference (RR = 0.93, 95% CI = 0.774-1.111, P > .05) in the incidence of postoperative delirium between the GA group and the SA group. In intraoperative blood transfusion (RR = 1.0, 95% CI = 0.77-1.28, Z = 0.04, P = .971), pulmonary embolism (RR = 0.795, 95% CI = 0.332-1.904, Z = 0.59, P = .606), pneumonia (RR = 1.47, 95% CI = 0.75-2.87, P = .675), myocardial infarction (RR = 0.97, 95% CI = 0.24-3.86, Z = 0.05, P = .961), heart failure (RR = 0.80, 95% CI = 0.26-2.42, Z = 0.40, P = .961), urinary retention (RR = 1.42, 95% CI = 0.77-2.61, Z = 1.11, P = .267) were similar between the 2 anesthetic techniques.

Conclusion: There is no significant difference in the effect of GA and SA on postoperative delirium in elderly patients with hip fracture, and their effects on postoperative complications are similar.

Figure 1.

Risk of bias. (A) Risk of bias summary: review authors’ judgements about each risk of bias item for each included study. (B) Risk of bias graph: review authors’ judgements about each risk of bias item presented as percentages across all included studies.

Figure 2.

Diagram of study selection. GA = general anesthesia, SA = spinal anesthesia.

Figure 3.

Funnel diagram of each complication. (A) Postoperative delirium. (B) Number of intraoperative blood transfusions. (C) Postoperative pulmonary embolism. (D) Postoperative pneumonia. (E) Postoperative myocardial infarction. (F) Postoperative heart failure. (G) Postoperative urinary retention.

Figure 4.

Star diagram of delirium.

Figure 5.

Meta-analysis of the occurrence of delirium after general and spinal anesthesia. CI = confidence interval, GA = general anesthesia, M-H = Mantel–Haenszel, RR = relative risk, SA = spinal anesthesia.

Figure 6.

Other meta-analysis results of general anesthesia and spinal anesthesia. (A) Intraoperative blood transfusion. (B) Pulmonary embolism. (C) Pneumonia. (D) Myocardial infarction. (E) Heart failure. (F) Urinary retention. CI = confidence interval, GA = general anesthesia, M-H = Mantel–Haenszel, RR = relative risk, SA = spinal anesthesia.