Outcomes with spinal versus general anesthesia for patients with and without preoperative cognitive impairment: Secondary analysis of a randomized clinical trial

Kyra O'Brien; Rui Feng; Frederick Sieber; Edward R Marcantonio; Ann Tierney; Jay Magaziner; Jeffrey L Carson; Derek Dillane; Daniel I Sessler; Diane Menio; Sabry Ayad; Trevor Stone; Steven Papp; Eric S Schwenk; Mitchell Marshall; J Douglas Jaffe; Charles Luke; Balram Sharma; Syed Azim; Robert Hymes; Ki-Jinn Chin; Richard Sheppard; Barry Perlman; Joshua Sappenfield; Ellen Hauck; Mark A Hoeft; Jason Karlawish; Samir Mehta; Derek J Donegan; Annamarie Horan; Susan S Ellenberg; Mark D Neuman; REGAIN (Regional versus General Anesthesia for Promoting Independence after Hip Fracture) Investigators

doi:10.1002/alz.13132

Outcomes with spinal versus general anesthesia for patients with and without preoperative cognitive impairment: Secondary analysis of a randomized clinical trial

Alzheimers Dement. 2023 Sep;19(9):4008-4019. doi: 10.1002/alz.13132. Epub 2023 May 12.

Authors

Kyra O'Brien¹, Rui Feng^{2

3}, Frederick Sieber⁴, Edward R Marcantonio⁵, Ann Tierney³, Jay Magaziner⁶, Jeffrey L Carson⁷, Derek Dillane⁸, Daniel I Sessler⁹, Diane Menio¹⁰, Sabry Ayad⁹, Trevor Stone¹¹, Steven Papp¹², Eric S Schwenk¹³, Mitchell Marshall¹⁴, J Douglas Jaffe¹⁵, Charles Luke¹⁶, Balram Sharma¹⁷, Syed Azim¹⁸, Robert Hymes¹⁹, Ki-Jinn Chin²⁰, Richard Sheppard²¹, Barry Perlman²², Joshua Sappenfield²³, Ellen Hauck²⁴, Mark A Hoeft²⁵, Jason Karlawish²⁶, Samir Mehta²⁷, Derek J Donegan²⁷, Annamarie Horan²⁷, Susan S Ellenberg^{2

3}, Mark D Neuman^{26

28}; REGAIN (Regional versus General Anesthesia for Promoting Independence after Hip Fracture) Investigators

Affiliations

¹ Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
² Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
³ Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
⁴ Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
⁵ Department of Medicine, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts, USA.
⁶ Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.
⁷ Division of General Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
⁸ Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Canada.
⁹ Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA.
¹⁰ Center for Advocacy for the Rights and Interests of the Elderly, Philadelphia, Pennsylvania, USA.
¹¹ Department of Orthopaedics, University of British Columbia, Vancouver, Canada.
¹² Division of Orthopaedics, Ottawa Hospital Civic Campus, Ottawa, Canada.
¹³ Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
¹⁴ Department of Anesthesiology, New York University Langone Medical Center, New York, New York, USA.
¹⁵ Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
¹⁶ Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
¹⁷ Department of Anesthesiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA.
¹⁸ Department of Anesthesiology, Stony Brook University, Stony Brook, New York, USA.
¹⁹ Department of Orthopedic Surgery, Inova Fairfax Medical Campus, Falls Church, Virginia, USA.
²⁰ Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada.
²¹ Department of Anesthesiology, Hartford Hospital, Hartford, Connecticut, USA.
²² Department of Internal Medicine, Peacehealth Medical Group, Springfield, Oregon, USA.
²³ Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA.
²⁴ Department of Anesthesiology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA.
²⁵ Department of Anesthesiology, University of Vermont Larner College of Medicine, Burlington, Vermont, USA.
²⁶ Department of Internal Medicine, Division of Geriatric Medicine, Perelman School of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
²⁷ Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
²⁸ Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.

PMID: 37170754
DOI: 10.1002/alz.13132

Abstract

Introduction: The effect of spinal versus general anesthesia on the risk of postoperative delirium or other outcomes for patients with or without cognitive impairment (including dementia) is unknown.

Methods: Post hoc secondary analysis of a multicenter pragmatic trial comparing spinal versus general anesthesia for adults aged 50 years or older undergoing hip fracture surgery.

Results: Among patients randomized to spinal versus general anesthesia, new or worsened delirium occurred in 100/295 (33.9%) versus 107/283 (37.8%; odds ratio [OR] 0.85; 95% confidence interval [CI] 0.60 to 1.19) among persons with cognitive impairment and 70/432 (16.2%) versus 71/445 (16.0%) among persons without cognitive impairment (OR 1.02; 95% CI 0.71 to 1.47, p = 0.46 for interaction). Delirium severity, in-hospital complications, and 60-day functional recovery did not differ by anesthesia type in patients with or without cognitive impairment.

Discussion: Anesthesia type is not associated with differences in delirium and functional outcomes among persons with or without cognitive impairment.

Keywords: anesthesia; delirium; dementia; hip fracture; mild cognitive impairment; surgery.

Publication types

Randomized Controlled Trial
Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Anesthesia, General / adverse effects
Cognitive Dysfunction* / complications
Delirium* / etiology
Hip Fractures* / complications
Hip Fractures* / surgery
Humans
Postoperative Complications