The impact of regional versus general anesthesia on postoperative neurocognitive outcomes in elderly patients undergoing hip fracture surgery: A systematic review and meta-analysis

Aug 28, 2022International journal of surgery (London, England)

How Regional and General Anesthesia Affect Thinking and Memory After Hip Surgery in Older Adults

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Abstract

Eight studies involving 3555 elderly patients indicated no significant difference in cognitive dysfunction outcomes between general and regional anesthesia.

The prevalence of postoperative delirium and cognitive dysfunction was similar for both anesthesia types at 24 hours, 3 days, and 7 days post-surgery.
At 24 hours, the odds ratio for cognitive dysfunction was 0.73, indicating no significant difference (P = 0.63).
At 3 days, the odds ratio was 1.03, also showing no significant difference (P = 0.82).
At 7 days, the odds ratio was 0.79, again reflecting no significant difference (P = 0.47).
No significant differences were found in the incidence of other adverse events associated with either anesthesia technique.

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BACKGROUND: Randomized trials have shown conflicting results regarding differences in outcomes according to anesthesia type on the prevalence of postoperative delirium (POD) or postoperative cognitive dysfunction (POCD) in hip surgery patients. The aim of this Meta analysis is to compare the effect of general and regional anesthesia in older patients undergoing hip fracture surgery.

METHODS: A literature search for meta-analysis was performed using Pubmed, The Cochrane Library, Embase and Web of Science citation index for randomized controlled trials (RCTs) to compare the regional anesthesia (RA) to general anesthesia (GA) for postoperative outcomes in elderly undergoing hip fracture surgery till June 2022. The primary outcomes were the incidence of POD or POCD at 24 h, 3 days and 7 days postoperatively. The secondary outcomes were 30 days mortality rate and other adverse events. The risk of bias was assessed using the Cochrane methodology.

RESULTS: Eight studies including 3555 elderly patients over 65 years old showed that there was no significant difference in the prevalence of POD or POCD between RA and GA at 24 h [OR 0.73; 95% coincidence interval (CI) 0.19, 2.71, I = 53%; n = 452; P = 0.63], at 3 days [OR 1.03; 95% CI 0.79, 1.35, I = 0%; n = 1362; P = 0.82], at 7 days [OR 0.79; 95% CI 0.41, 1.52, I = 51%; n = 1336; P = 0.47], respectively. No significant differences were observed in the incidence of other adverse events. 2 2 2

CONCLUSIONS: No significant difference was found in the incidence of cognitive dysfunction after either general or regional anesthesia in elderly patients. Our finding of similar outcomes at 24 h, 3 days and 7 days postoperatively with either technique suggests that anesthesia choices for hip-fracture surgery may be based on the individual characteristics of each patient rather than on anticipated differences in clinical outcomes.

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The impact of regional versus general anesthesia on postoperative neurocognitive outcomes in elderly patients undergoing hip fracture surgery: A systematic review and meta-analysis

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