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

被引：22

作者：

Vail, Emily A. ^{[1
]}

Feng, Rui ^{[2
]}

Sieber, Frederick ^{[3
]}

Carson, Jeffrey L. ^{[4
]}

Ellenberg, Susan S. ^{[2
]}

Magaziner, Jay ^{[5
]}

Dillane, Derek ^{[6
]}

Marcantonio, Edward R. ^{[7
]}

Sessler, Daniel I. ^{[8
]}

Ayad, Sabry ^{[8
]}

Stone, Trevor ^{[9
]}

Papp, Steven ^{[10
]}

Donegan, Derek ^{[11
]}

Mehta, Samir ^{[11
]}

Schwenk, Eric S. ^{[12
]}

Marshall, Mitchell ^{[13
]}

Jaffe, J. Douglas ^{[14
]}

Luke, Charles ^{[15
]}

Sharma, Balram ^{[16
]}

Azim, Syed ^{[17
]}

Hymes, Robert ^{[18
]}

Chin, Ki-Jinn ^{[19
]}

Sheppard, Richard ^{[20
]}

Perlman, Barry ^{[21
]}

Sappenfield, Joshua ^{[22
]}

Hauck, Ellen ^{[23
]}

Tierney, Ann ^{[24
]}

Horan, Annamarie D. ^{[25
]}

Neuman, Mark D. ^{[1
,26
]}

机构：

[1] Univ Penn, Dept Anesthesiol & Crit Care, Philadelphia, PA 19104 USA

[2] Univ Penn, Perelman Sch Med, Dept Biostat Epidemiol & Informat, Philadelphia, PA USA

[3] Johns Hopkins Med Inst, Dept Anesthesiol & Crit Care Med, Baltimore, MD USA

[4] Rutgers Robert Wood Johnson Med Sch, Div Gen Internal Med, New Brunswick, NJ USA

[5] Univ Maryland, Sch Med, Dept Epidemiol & Publ Hlth, Baltimore, MD USA

[6] Univ Alberta Hosp, Dept Anesthesiol & Pain Med, Edmonton, AB, Canada

[7] Beth Israel Deaconess Med Ctr, Dept Med, Boston, MA USA

[8] Cleveland Clin, Dept Outcomes Res, Cleveland, OH USA

[9] Univ British Columbia, Dept Orthoped, Vancouver, BC, Canada

[10] Ottawa Hosp, Div Orthoped, Civ Campus, Ottawa, ON, Canada

[11] Univ Penn, Perelman Sch Med, Dept Orthoped Surg, Philadelphia, PA USA

[12] Thomas Jefferson Univ, Sidney Kimmel Med Coll, Dept Anesthesiol, Philadelphia, PA USA

[13] NYU Langone Med Ctr, Dept Anesthesiol, New York, NY USA

[14] Wake Forest Sch Med, Dept Anesthesiol, Winston Salem, NC USA

[15] Univ Pittsburgh, Med Ctr, Dept Anesthesiol, Pittsburgh, PA USA

[16] Lahey Hosp & Med Ctr, Dept Anesthesiol, Burlington, MA USA

[17] SUNY Stony Brook, Dept Anesthesiol, Stony Brook, NY USA

[18] Dept Orthoped Surg, Inova Fairfax Med Campus, Falls Church, VA USA

[19] Univ Toronto, Dept Anesthesiol & Pain Med, Toronto, ON, Canada

[20] Hartford Hosp, Dept Anesthesiol, Hartford, CT USA

[21] Peacehlth Med Grp, Springfield, OR USA

[22] Univ Florida, Coll Med, Dept Anesthesiol, Gainesville, FL USA

[23] Temple Univ, Lewis Katz Sch Med, Dept Anesthesiol, Philadelphia, PA USA

[24] Univ Penn, Ctr Clin Epidemiol & Biostat, Perelman Sch Med, Philadelphia, PA USA

[25] Univ Penn, Dept Anesthesiol & Crit Care, Philadelphia, PA USA

[26] Univ Penn, Perelman Sch Med, 308 Blockley Hall, 423 Guardian Dr, Philadelphia, PA 19106 USA

来源：

ANESTHESIOLOGY | 2024年 / 140卷 / 03期

关键词：

THERAPY AMERICAN-SOCIETY; REGIONAL-ANESTHESIA; MORTALITY;

D O I：

10.1097/ALN.0000000000004807

中图分类号：

R614 [麻醉学];

学科分类号：

100217 ;

摘要：

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.

引用

页码：375 / 386

页数：12

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