In the Literature

Summary of "Neuraxial versus general anesthesia in elderly patients undergoing hip fracture surgery and the incidence of postoperative delirium: a systematic review and stratified meta-analysis"

Summary published November 20, 2023

Summary by Brian J. Thomas, JD

BMC Anesthesiology | July 2023

Cheung KY, Yang TX, Chong DY, So EH. Neuraxial versus general anesthesia in elderly patients undergoing hip fracture surgery and the incidence of postoperative delirium: a systematic review and stratified meta-analysis. BMC Anesthesiol. 2023 Jul 22;23(1):250. doi: 10.1186/s12871-023-02196-9. PMID: 37481517; PMCID: PMC10362612.

doi: https://doi.org/10.1186/s12871-023-02196-9

  • In this meta-analysis, the authors identified a total of 10 random controlled trials (RCTs) including 3968 patients published from 2000 to December 2021, in English and non-English language, searching PubMed, EMBASE, Google Scholar, Web of Science and the Cochrane Library database to identify the RCTs if they included postoperative delirium incidence (POD), cognitive impairment, mortality, duration of hospital stay, or rehabilitation capacity reports as at least one of the outcomes.
  • The authors primary objective was investigating the impact of neuraxial anesthesia (NA) versus general anesthesia (GA) in elderly patients undergoing hip fracture repair on postoperative delirium (POD), cognitive impairment, and associated clinical implications including mortality, duration of hospital stay, and functional recovery.
  • Two investigators independently screened studies for inclusion and performance data extraction. The risk of bias was assessed using the Cochrane Collaboration risk-of-bias tool. The odds ratio (OR) and 95% confidence intervals (CI) were calculated to assess the pooled data.
  • There were no statistically significant differences identified in POD incidence between NA and GA groups [OR 1.10, 95% CI (0.89 to 1.37)], with or without including patients with a pre-existing condition of dementia or delirium, POD incidence from postoperative day 2-7 [OR 0.31, 95% CI (0.06 to -1.63)], in mini-mental state examination (MMSE) score [OR 0.07, 95% CI (-0.22 to 0.36)], or other neuropsychological test results.
  • NA appeared to be associated with shorter hospital stay, especially in patients without pre-existing dementia, but the observed effect did not reach statistical significance.
  • The study’s authors concluded that larger prospective randomized trials with a uniform and clear definition of POD, outcomes on delirium prevalence or duration, rehabilitation and postoperative functionality are required.