General Anesthesia Versus Regional Anesthesia in the Elderly Patients Undergoing Hip Fracture Surgeries: A Systematic Review and Meta‐Analysis of Randomized Clinical Trials

Feb 24, 2023World journal of surgery

General anesthesia versus regional anesthesia in older adults having hip fracture surgery: A review of clinical trials

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Abstract

A total of 3594 patients were analyzed, revealing that regional anesthesia (RA) is associated with shorter surgery duration and less intraoperative blood loss compared to general anesthesia (GA).

RA resulted in shorter length of hospital stays compared to GA.
No significant differences were found between RA and GA in blood transfusions or duration of anesthesia.
30-day mortality rates and postoperative delirium were similar for both anesthesia techniques.
The findings suggest that RA may be a preferable option for elderly patients undergoing hip fracture surgeries.

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BACKGROUND: Surgery is the preferred treatment option for the elderly patients with hip fractures. However, the choice of general anesthesia (GA) or regional anesthesia (RA) remains controversial. The quality of evidence has further improved with the advent of several high-quality randomized clinical trials (RCTs) in the last two years. The purpose of this study was to compare the clinical outcomes of two anesthetic techniques in elderly patients undergoing hip fracture surgeries.

METHODS: Eligible studies were identified from PubMed/MEDLINE, Web of Science, Scopus, EMBASE and reference lists from January 2000 to June 2022 in this current systematic review and meta-analysis. The outcomes included the surgery-related outcomes (duration of surgery, duration of anesthesia, intraoperative blood loss and number of transfusions) and postoperative outcomes (30-day mortality, postoperative delirium,cardiovascular events and other complications).

RESULTS: A total of 10 RCTs were included, and a total of 3594 patients were analyzed. RA was associated with shorter duration of surgery, shorter length of hospital stays and less intraoperative blood loss compared to GA. There were no significant differences between the two groups in the number of blood transfusions, duration of anesthesia, 30-day mortality or postoperative delirium.

CONCLUSIONS: Our pooled analysis identified no significant differences in terms of the safety between RA and GA, while RA reduces intraoperative blood loss, length of hospital stays and duration of surgery. These results suggest that RA appears to be preferable for the elderly patients with hip fractures.

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General Anesthesia Versus Regional Anesthesia in the Elderly Patients Undergoing Hip Fracture Surgeries: A Systematic Review and Meta‐Analysis of Randomized Clinical Trials

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