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Randomized Controlled Trial
. 2025 Jul;80(7):771-780.
doi: 10.1111/anae.16545. Epub 2025 Jan 23.

Incidence of 12-month postoperative cognitive decline following regional vs. general anaesthesia in older patients undergoing hip fracture surgery: follow-up of the RAGA trial

Ting Li  1   2 , Jun Li  1 , Chenchen Jiang  2 , Liyong Yuan  3 , Jinze Wu  4 , Ali Mazaheri  5 , Mingcang Wang  6 , Shengwei Jin  1 , Paul S Myles  7 , Yinguang Yao  8 , Jimin Wu  9 , Junping Chen  10 , Fang G Smith  2   11 ; RAGA study investigators
Affiliations
Randomized Controlled Trial

Incidence of 12-month postoperative cognitive decline following regional vs. general anaesthesia in older patients undergoing hip fracture surgery: follow-up of the RAGA trial

Ting Li et al. Anaesthesia. 2025 Jul.

Abstract

Introduction: Data regarding the incidence of 12-month postoperative cognitive decline following regional or general anaesthesia in older patients undergoing hip fracture surgery remain observational. Compared with general anaesthesia, we hypothesised that regional anaesthesia would decrease the incidence of 12-month postoperative cognitive decline.

Methods: This is substudy of a multicentre randomised trial of regional anaesthesia with no sedation vs. general anaesthesia with 12-month follow-up, conducted in nine university hospitals in south-eastern China. Patients aged ≥ 65 y with hip fractures requiring surgery were eligible for inclusion. The prespecified 1-year primary outcome was the incidence of postoperative cognitive decline at 12 months post-randomisation. Secondary outcomes included major or mild postoperative cognitive decline; changes in Mini-Mental State Examination; newly developed dementia; affective status; and health-related quality of life.

Results: We recruited 950 patients between October 2014 and September 2018 (n = 474 general and n = 476 regional), with the last participant interviewed in November 2019. A total of 293 patients (139 general vs. 154 regional) were included in the primary analysis of the 12-month outcome. Median (IQR [range]) age of patients was 78 (71-82 [65-96]) y and 217 (74.1%) were female. The incidence of cognitive decline at 12 months was 29.7% vs. 25.4% of patients allocated to general vs. regional anaesthesia, respectively (unadjusted OR 1.2 (95%CI 0.7-2.1), p = 0.43, Bayes factor = 0.28). Major cognitive decline developed in 8.6% vs. 8.5% of patients allocated to general vs. regional anaesthesia, respectively (unadjusted OR 1.0 (95%CI 0.4-2.4)).

Discussion: The incidence of 12-month postoperative cognitive decline was not significantly different in patients having general or regional anaesthesia for hip fracture surgery.

Keywords: general anaesthesia; hip fracture; neurocognitive function; older patients; regional anaesthesia.

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Figures

Figure 1
Figure 1
Study flowchart. MMSE, Mini‐Mental State Examination; SF‐36, 36‐item Short Form survey; HADS, Hospital Anxiety and Depression Scale.
Figure 2
Figure 2
Subgroup analyses of the primary outcome for patients undergoing surgery for hip fracture.
Figure 3
Figure 3
Alluvial plot of peri‐operative neurocognitive function in patients undergoing surgery for hip fracture. (a) Represents patients of each group across three events (pre‐operative, postoperative 7 days and up to 12‐month follow‐up). (b) Represents patients of each group across two events (pre‐operative and up to 12‐month follow‐up). Left hand panels: general anaesthesia group; right hand panels: regional anaesthesia group. 1, normal; 2, mild cognitive impairment; 3, dementia; 4, no delirium; 5, delirium symptoms. formula image Lost or withdrew; formula image dead; formula image mild cognitive decline; formula image major cognitive decline; formula image improved; formula image unchanged.
See this image and copyright information in PMC

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