Does spinal anesthesia for pelvic fracture repair surgery help in faster recovery?

At the time of writing this article, the effects of spinal anesthesia compared to general anesthesia on the ability of elderly people undergoing surgery for a hip fracture to walk again have not been properly investigated.

General anesthesia. The study involved ambulatory patients aged 50 years and older who had to undergo pelvic fracture repair surgery, in 46 hospitals in the United States and Canada. Patients were randomly assigned a 1: 1 ratio for spinal or general anesthesia. The main outcome tested was a mortality or inability to walk three meters independently or with a cane / walker 60 days after the random assignment. Secondary outcomes included mortality within 60 days, delirium, time to discharge from hospitalization and independent mobility (ambulation) after 60 days.

1,600 subjects were recruited for the study; 795 were assigned to receive spinal anesthesia and 805 were assigned to receive general anesthesia. The average age of the patients was 78 years, and 67% of them were women. Of the subjects assigned to receive spinal anesthesia 666 received the type of anesthesia assigned (83.8%), and of the subjects assigned to receive general anesthesia 769 received the type of anesthesia assigned (95.5%). Of the patients in the revised intention-to-treat population for whom information is available, 132 of 712 (18.5%) were examined in the spinal anesthesia group, and 132 of 733 (18%) in the general anesthesia group reached the primary outcome (risk ratio of 1.03, profit margin- 95% confidence, 0.59-1.57). Delirium events occurred in 130 of 633 subjects (20.5%) in the spinal anesthesia group and in 124 of 629 (19.7%) in the general anesthesia group (risk ratio of 1.04, 95% confidence interval, 0.84-1.3).

The researchers concluded that spinal anesthesia is not preferable to general anesthesia with respect to survival and return to emulation 60 days after surgery. The incidence rates of delirium after surgery were the same between the two study groups.

Source:

Mark D. Neuman, et al. (2021) “Spinal Anesthesia or General Anesthesia for Hip Surgery in Older Adults. ” The New England Journal of Medicine, November 2021. Vol. 385, p. 2025-2035. DOI: 10.1056 / NEJMoa2113514

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