Skip to main content
Download PDF

Perioperative outcomes in different anesthesia techniques for patients undergoing hip fracture surgery: a systematic review and meta-analysis

BMC Anesthesiology volume 23, Article number: 184 (2023) Cite this article

Abstract

Background

Previous studies of the perioperative effects of general and regional anesthesia in adult patients undergoing effects of different anesthesia techniques on patients undergoing hip fracture surgery have not produced consistent results. The aim of this systematic review and meta-analysis was to compare the hip fracture surgery.

Methods

We performed a systematic review and meta-analysis to compare the effects of general anesthesia with regional anesthesia on in-hospital mortality, 30-day mortality, postoperative pneumonia, and delirium in adult hip fracture patients (≥ 18 years). Between January 1, 2022, and March 31, 2023, a systematic search was performed for retrospective observational and prospective randomized controlled studies in PubMed, Ovid Medline, Cochrane Library, and Scopus.

Results

Twenty-one studies including 363,470 patients showed higher in-hospital mortality in the general anesthesia group compared with regional anesthesia (OR = 1.21; 95% CI 1.13–1.29; P < 0.001, n = 191,511). The 30-day mortality (OR = 1.00; 95% CI 0.96–1.05; P = 0.95, n = 163,811), the incidence of postoperative pneumonia (OR = 0.93; 95% CI 0.82–1.06; P = 0.28, n = 36,743) and the occurrence of postoperative delirium in the two groups (OR = 0.94; 95% CI 0.74–1.20; P = 0.61, n = 2861) had no significant difference.

Conclusion

Regional anesthesia is associated with reduced in-hospital mortality. However, the type of anesthesia did not affect the occurrence of 30-day mortality, postoperative pneumonia, and delirium. A large number of randomized studies are needed in the future to examine the relationship between type of anesthesia, postoperative complications, and mortality.

Peer Review reports

Background

Due to the aging population, the absolute total number of hip fractures among people aged 55 years and older increased approximately four-fold between 2012 and 2016 in China [1]. With the 1.6 million hip fracture surgeries performed each year worldwide from 2016 to 2020, the risk of death within 30 days after surgery increased by 6.7% to 8.2% [2]. What is more, hip fracture surgery is expected to increase to 6.25 million per year by 2050 [3].

Previous studies to date have not provided sufficient evidence to determine the ideal mode of anesthesia. Studies evaluating general anesthesia versus regional anesthesia have produced inconsistent results when mortality was included as the primary outcome. Previous systematic reviews aimed at assessing this issue have been limited by the inadequate samples and generally low quality of randomized trials. In the past two years, large-scale high-quality randomized controlled studies have emerged, focusing on evaluating the impact of regional anesthesia and general anesthesia on the incidence of delirium in patients after hip fracture surgery [4, 5]. To integrate the impact of different anesthesia ways on post-surgery complications in previous studies, now we performed a meta-analysis of this result.

This systematic review and meta-analysis aimed to identify studies in the context of the type of anesthesia in patients undergoing hip fracture surgery. In-hospital mortality, pneumonia, and delirium were reviewed in recent 20 years in order to assess the effect of different anesthesia techniques after hip fracture in prospective randomized and retrospective observational studies.

Methods

The study protocol has not been published before. This systematic review and meta-analysis adhered to the preferred reporting item of the guidelines for systematic reviews and meta-analysis [6]. The systematic evaluation and meta-analysis of observational studies followed the MOOSE (Meta-analysis of Observational Studies in Epidemiology) guidelines. It has been registered in the international prospective register of systematic reviews (Prospero: CRD42022372145).

Inclusion and exclusion criteria

All the authors identified exclusion and inclusion criteria in advance before conducting a systematic review and meta-analysis. This systematic review and meta-analysis focused on the latest research evaluating modern anesthesia techniques. We included only human studies published between January 1, 2002, and March 31, 2023, evaluating the perioperative outcomes of general anesthesia versus regional anesthesia in adults with hip fractures. Prospective and retrospective randomized trials and observational studies were eligible for this review which addressed the incidence of in-hospital mortality, 30-day mortality, postoperative pneumonia, and delirium. Articles were excluded if the outcome parameters did not fit the outcome variables of this study. Case series, Case reports, systematic reviews, and meta-analysis were excluded.

Literature searches

A systematic search was performed through PubMed, Ovid Medline, Cochrane Library, and Scopus. In PubMed, the full search strategy was: (((anesthesia [Mesh]) OR (anesthesia)) OR (anaesthesia)) AND (((((hip fractures [Mesh]) OR (hip fractures)) OR ((hip) AND (fractures))) OR (hip fracture)) OR ((hip) AND (fracture))) AND ((2002/1/1[PDAT]: 2023/3/31[PDAT])). The Detail literature search strategies in different databases were displayed in the form of Supplemental 1.

Study selection was based on independent screening of titles and abstracts in initial searches by two researchers (BM and HX). Qualified studies were independently reviewed in full by the same two reviewers for eligibility. Disagreement on study eligibility was discussed and resolved by consultation with the third author (HL).

Data extraction

Data extraction from the included literature was executed independently by two investigators (BM and HX). For each eligible study, the information about the first author, country, type of study, anesthesia technique, detailed method of local anesthesia (technology, mode of administration, drug type, concentration, and dose), and the diagnostic criteria of complications were collected and recorded in Table 1. The information related to in-hospital mortality, 30-day mortality, the rate of postoperative pneumonia and delirium, and the main conclusions was collected and recorded in Table 2. The meta-analysis included at least two randomized or non-randomized studies comparing general anesthesia and regional anesthesia. The primary outcomes were mortality including in-hospital mortality and 30-day mortality. The secondary outcomes were the rate of postoperative pneumonia and delirium. The results of the different groups were reported in the same way. The number of events was extracted for dichotomous outcomes and the mean and standard deviation were extracted for continuous outcomes.

Table 1 Demographic characteristics of the included studies
Full size table
Table 2 Complications and findings in included studies
Full size table

Statistical methods

Review Manager software (Revman for Mac, version 5.3; using the Cochrane Collaboration, Oxford, UK) and Stata statistical software version 12.0 (Stata Corp LP, College Station, TX) were used for meta-analysis. The count data and measurement data were represented by odds ratio (OR) and weighted mean difference (WMD) and their 95% Confidence Interval (CI) representation. If at least two studies reported comparable outcomes, the results of the studies were pooled. This allowed the generation of forest plots, testing for statistical heterogeneity, and the overall estimation of the combined effect of each outcome. The similarity between studies was measured using the I2 statistic to estimate the proportion of differences between studies due to heterogeneity rather than chance. For analyzing the heterogeneity, when the between-study heterogeneity was absent in the included studies (I2 < 50%), the fixed effect model was used. whereas the random-effects model was applied when between-study heterogeneity was statistically necessary (I2 > 50%) [26]. To confirm the reliability of the results in this review, the sensitivity analysis was conducted by the one-by-one elimination method using the Stata. Publication bias was assessed by visual inspection of the funnel plot using the Stata. P values < 0.05 were considered statistically significant.

Assessment of risk of bias

Two investigators (BM and HX) independently assessed the risk of bias in each study. The RCT study applied the randomization research tool of the Cochrane Collaboration [27]. For nonrandomized studies, the Cochrane ACROBAT-NRSI tool [28] was used. Each domain of the Cochrane tool assigned studies as low risk of bias, high risk of bias, or unclear risk of bias.

Result

Study selection

Firstly, 3735 studies were identified by using PubMed, Ovid Medline, Cochrane Library, and Scopus databases. After removing duplicates, 1701 titles and abstracts were screened. Of these, 1275 were excluded from titles and abstracts. Based on the remaining 426 records, 405 articles were eliminated by reading the full text due to a lack of to be analyzed. Finally, 21 articles were included in the final analysis [4, 5, 7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25], as shown in Fig. 1. The detailed literature search strategies in different databases were displayed in Supplementary material 1.

Fig. 1
figure 1

Flow chart presenting the steps of literature search and selection

Full size image

Characteristics of eligible studies

The detailed characteristics of the studies were shown in Tables 1 and 2. Among the 21 studies included in the analysis, 17 were retrospective observational studies and 4 were randomized controlled studies [4, 5, 7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25]. Overall, 363,470 patients were analyzed in this systematic review and meta-analysis. 228,713 patients received general anesthesia and 134,757 patients received regional anesthesia. The sample sizes of the included studies varied widely, ranging from 129 to 104,088. Regional anesthesia included the use of a neuraxial technique (spinal anesthesia, epidural anesthesia, continuous spinal anesthesia, continuous epidural anesthesia, or combined spinal-epidural anesthesia) with or without the use of a nerve block or multiple nerve blocks. One study did not provide a definition of regional anesthesia [16].

Risk of bias

Analysis of the risk of bias for randomized controlled studies and retrospective observational studies are shown in Fig. 2. The authors’ judgments about each risk of bias item for each included study were described. The details were shown in Supplementary material 2 and 3.

Fig. 2
figure 2

Cochrane collaboration risk of bias for A randomized controlled studies and B retrospective observational studies

Full size image

Meta-analysis results

In-hospital mortality

The in-hospital mortality was examined by 6 retrospective observational studies after hip fracture surgery in adults [8, 10, 11, 15, 16, 21]. 4 studies showed that there was no significant difference in in-hospital mortality in patients receiving either general or regional anesthesia [8, 11, 15, 21]. But Neuman and his colleagues (n = 18,158, general anesthesia = 12,904, regional anesthesia = 5254) revealed that the in-hospital mortality rate in the general anesthesia group was higher than regional anesthesia group [16]. The study of Chu and his colleagues (n = 104,088, general anesthesia = 52,044, regional anesthesia = 52,044) reported a significantly higher incidence of in-hospital mortality in the general anesthesia group [10]. Our meta-analysis, including the above 6 studies, showed a higher in-hospital mortality in the general anesthesia group than in the regional anesthesia group (OR = 1.21; 95% CI 1.13–1.29; P < 0.001, n = 191,511) without heterogeneity (I2 = 0%). The details were shown in Fig. 3.

Fig. 3
figure 3

Forest plots showing pooled effect estimates for in-hospital mortality when comparing general with regional anesthesia. The odds ratio was calculated with a fixed effect method

Full size image

30-day mortality

Thirteen studies investigated the effect of general versus regional anesthesia on 30-day mortality after hip fracture surgery in adult patients including 2 prospective randomized controlled studies and 11 retrospective observational studies [4, 7,8,9, 14, 17,18,19,20, 22,23,24,25]. The study of Radcliff and his colleagues (n = 5683, general anesthesia = 3353, regional anesthesia = 2330) reported a significantly higher risk of 30-day hospital mortality in the general anesthesia group [19]. The other studies showed that there was no significant difference in the 30-day mortality between general and regional anesthesia in the above studies [4, 7,8,9, 14, 17, 18, 20, 22,23,24,25]. Our meta-analysis of these 13 studies showed no statistically significant difference in 30-day mortality (OR = 1.00; 95% CI 0.96–1.05; P = 0.95, n = 163,811) without heterogeneity (I2 = 0%). The subgroup analysis for 2 randomized controlled studies (OR = 0.90; 95% CI 0.41–2.00; P = 0.80, n = 1264) and 9 retrospective observational studies (OR = 1.00; 95% CI 0.95–1.04; P = 0.89, n = 155,797) also indicated no statistical difference in the 30-day mortality between the two groups, as shown in Fig. 4.

Fig. 4
figure 4

Forest plots showing pooled effect estimates for 30-day mortality when comparing general with regional anesthesia. The odds ratio was calculated with a fixed effect method. 4.1.1: The odds ratio of the randomized controlled studies represented a subgroup. 4.1.2: The odds ratio of the retrospective observational studies represented a subgroup

Full size image

Pneumonia

Eight studies investigated the incidence of pneumonia after hip fracture surgery in adults, including 3 randomized controlled studies and 5 retrospective observational studies [4, 7, 8, 12, 13, 16, 18, 21]. Among them, Neuman et al. (n = 18,158, general anesthesia = 12,904, regional anesthesia = 5254), Fields et al. (n = 6628, general anesthesia = 4813, regional anesthesia = 1815) and Shih et al. (n = 335, general anesthesia167, regional anesthesia = 168) found a higher incidence of pneumonia in the general anesthesia group [12, 16, 21]. The other studies revealed no significant difference in the incidence of pneumonia between the two groups [4, 7, 8, 13, 18]. These 8 studies were eligible to be included in the meta-analysis. There was no statistical difference in the incidence of pneumonia between the two groups (OR = 0.93; 95% CI 0.82–1.06; P = 0.28, n = 36,743) without heterogeneity (I2 = 0%). The subgroup analysis for 3 randomized controlled studies (OR = 0.78; 95% CI 0.21–2.91; P = 0.71, n = 1651) and 5 retrospective observational studies (OR = 0.93; 95% CI 0.83–1.06; P = 0.30, n = 35,092) indicated no statistical difference in the incidence of pneumonia between the two groups, as shown in Fig. 5.

Fig. 5
figure 5

Forest plots showing pooled effect estimates for pneumonia when comparing general with regional anesthesia. The odds ratio was calculated with a fixed effect method. 5.1.1: The odds ratio of the randomized controlled studies represented a subgroup. 5.1.2: The odds ratio of the retrospective observational studies represented a subgroup

Full size image

Delirium

Three prospective randomized controlled studies and 1 retrospective observational study evaluated the incidence of postoperative delirium between general anesthesia and regional anesthesia in adults. As there was only 1 retrospective study, subgroup analysis was not possible. There was no significant difference in the occurrence of postoperative delirium between general and regional anesthesia [4, 5, 18, 21]. Our meta-analysis of these 4 studies also showed no statistically significant difference between the two groups regarding the incidence of postoperative delirium (OR = 0.94; 95% CI 0.74–1.20; P = 0.61, n = 2861), without heterogeneity (I2 = 39%). The results were shown in Fig. 6.

Fig. 6
figure 6

Forest plots showing pooled effect estimates for delirium when comparing general with regional anesthesia. The odds ratio was calculated with a fixed effect method

Full size image

Sensitivity analysis

We used Stata 12.0 to perform sensitivity analysis using the one-by-one elimination method. For in-hospital mortality, the combined results of those 6 retrospective observational studies [8, 10, 11, 15, 16, 21] were greatly influenced by the study of Chu et al. [10] (OR = 1.21; 95% CI 1.13–1.29). After excluding this study, the remaining 5 retrospective observational studies [8, 11, 15, 16, 21] indicated there was no significant difference in in-hospital mortality (OR = 1.13; 95% CI 0.99–1.29; P = 0.09, n = 87,423) by Review Manager software. For 30-day mortality, two prospective randomized controlled studies [4, 18] and 11 retrospective observational studies [7,8,9, 14, 17, 19, 20, 22,23,24,25] showed no significant difference consistently with the original results (OR = 1.00; 95% CI 0.96–1.04). For the occurrence of postoperative pneumonia, 3 randomized controlled studies [4, 13, 18] and 5 retrospective observational studies [7, 8, 12, 16, 21] showed no significant difference between the 2 anesthesia types (OR = 0.93; 95% CI 0.82–1.06). 3 randomized controlled studies and 1 retrospective observational study evaluated the occurrence of postoperative delirium [4, 5, 18, 21] and showed no significant difference (OR = 0.95; 95% CI 0.78–1.16). These results were consistent with the original results indicating that the original results had high reliability (Supplementary material 4).

Publication bias

Publication bias was assessed by Begg’s test using Stata 12.0. The Begg’s funnel plot of in-hospital mortality(P = 0.858), 30-day mortality(P = 0.586), the incidence of pneumonia(P = 0.967), and delirium(P = 0.955) suggested that there was no publication bias, as shown in Fig. 7.

Fig. 7
figure 7

The Begg’s funnel plots of A in-hospital mortality, B 30-day mortality, C pneumonia and D delirium suggested that there was no publication bias

Full size image

Discussion

In this systematic review and meta-analysis, we included 21 studies (17 retrospective studies and 4 randomized controlled trials) involving 363,470 patients, of whom 228,713 patients received general anesthesia and 134,757 patients received regional anesthesia. This study showed that general anesthesia was associated with increased in-hospital mortality compared with regional anesthesia in adult patients undergoing hip fracture surgery. There were no significant differences in 30-day mortality, postoperative pneumonia, and delirium in those patients with hip fractures undergoing surgery where either general or regional anesthesia was used. For the outcome of in-hospital mortality, through one-by-one elimination methods, after excluding the study conducted by Chu et al., the outcome has changed to no significant differences in in-hospital mortality. It might be due to the study included 104,088 patients and accounted for 72.3% of the weight affected the outcome. Nevertheless, the result of in-hospital mortality of this meta-analysis was still plausible because there was no heterogeneity and the results showed significant differences for in-hospital mortality (I2 = 0, p < 0.001). In the future, more large-scale prospective randomized controlled trials might be needed to support the results. Chu et al. found that in hip fracture surgery, the risk factors for in-hospital mortality under general anesthesia compared with regional anesthesia in the elderly may be stroke and acute respiratory failure. Especially patients treated in regional hospitals had greater odds of postoperative stroke after general anesthesia [10]. Neuman et al. and Shin et al. attributed the higher in-hospital mortality under general anesthesia to increased respiratory postoperative complications in older patients [16, 21].

In 2010, Luger and his colleagues conducted a systematic study of the types of anesthesia used in hip fracture surgery. Their systematic review included literature from 1967 to 2010, including 34 randomized studies, 14 observational studies, and 8 systematic reviews and meta-analysis. The authors speculated that spinal anesthesia may be associated with significantly lower early mortality, fewer deep vein thrombotic events, less acute postoperative confusion, less propensity for myocardial infarction, and less pneumonia, fatal pulmonary embolism, and postoperative hypoxia. Because only 18,715 patients were included, the evidence was limited. It might be not suitable to draw definitive conclusions about mortality or other outcomes [29]. In 2016, Guay et al. conducted a systematic review in which they included only 31 randomized controlled studies from 2003 to 2014. There were only 3231 patients were included and only 2152 patients were available for examination of 30-day mortality. They found no difference between the two anesthesia techniques. The authors determined that the number of patients included in the study was insufficient to reveal the differences between general and regional anesthesia in hip fracture patients [30]. In 2017, a systematic review by Van Waesberghe and colleagues had several methodological weaknesses, such as the inclusion of data for patients undergoing elective total hip arthroplasty from ACS-NSQIP databases(America College of Surgeons National Quality Improvement Plan). Many patients from the databases were excluded because of incomplete documentation and many studies did not describe the dose and type of anesthetic. The results showed no difference in 30-day mortality between the two groups of hip fracture surgery patients. The group of nerve block anesthesia could significantly reduce the length of hospital stay and hospital mortality and reduce the incidence of myocardial infarction and respiratory failure [31]. However, In the same year, a systematic review published by O'Donnell and colleagues showed that there were no differences in the 30-day mortality and postoperative complications including the prevalence of pneumonia, acute myocardial infarction, delirium, and renal failure in patients undergoing hip fracture surgery in the two groups [32]. A limitation of the systematic review by O'Donnell and colleagues was that the diagnostic criteria were not standardized and uniform. For example, the definition of delirium was unclear. The patients with a decline in cognitive score in White's study were included in the analysis of delirium [24]. In Ilango's study included, the classification of anesthesia method was unclear and confusing. For example, patients who were sedated under regional anesthesia were recorded as general anesthesia [33]. In our study, we excluded ambiguous groups, such as the group of general anesthesia combined nerve block in Elisabetta's study [11] when in-hospital mortality was analyzed. In terms of 30-day mortality, the groups of general anesthesia combined with epidural or nerve block in the literature were excluded [9, 23, 24]. When analyzing the occurrence of postoperative delirium, we strictly screened the data and excluded the number of cases that did not fully match the definition of delirium, such as cognitive impairment and cognitive score decline, which limited the number of cases collected in the meta.

The systematic review and meta-analysis have several limitations. Firstly, the current evidence lacks high-quality randomized controlled trials, and most of our included studies were retrospective studies. Secondly, perioperative complications are common in elderly hip fracture patients. However, there was a lack of uniform detailed definitions and effective diagnostic criteria for postoperative complications. As a result, most studies were not included in the meta-analysis.

Conclusions

This review did not show any difference in 30-day mortality and the incidence of postoperative pneumonia and delirium between the general and regional anesthesia groups. The regional anesthesia group was associated with a reduction in in-hospital mortality, but the result was limited by large differences in sample size. More prospective randomized controlled trials are needed in the future. The focus must include clearly defined interventions and outcomes important to patients, as well as unified measurement methods [34] to draw more reliable conclusions.

Availability of data and materials

All data relevant to the study are included in the article or uploaded as supplementary information.

References

  1. Zhang C, Feng J, Wang S, et al. Incidence of and trends in hip fracture among adults in urban China: A nationwide retrospective cohort study. PLoS Med. 2020;17(8): e1003180.

    Article  PubMed  PubMed Central  Google Scholar 

  2. National Hip Fracture Database.Annual report, The National Hip Fracture Database (nhfd.co.uk), 2020. Available from. (Accessed 21 April 2022)

  3. Dhanwal DK, Dennison EM, Harvey NC, Cooper C. Epidemiology of hip fracture: Worldwide geographic variation. Indian J Orthop. 2011;45(1):15–22.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Li T, Li J, Yuan L, et al. Effect of Regional vs General Anesthesia on Incidence of Postoperative Delirium in Older Patients Undergoing Hip Fracture Surgery: The RAGA Randomized Trial [published correction appears in.  JAMA. 2022;327(12):1188.

    Google Scholar 

  5. Neuman MD, Feng R, Carson JL, et al. Spinal Anesthesia or General Anesthesia for Hip Surgery in Older Adults. N Engl J Med. 2021;385(22):2025–35.

    Article  CAS  PubMed  Google Scholar 

  6. Page MJ, Moher D, Bossuyt PM, et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ. 2021;372: n160.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Basques BA, Bohl DD, Golinvaux NS, Samuel AM, Grauer JG. General versus spinal anaesthesia for patients aged 70 years and older with a fracture of the hip. Bone Joint J. 2015; 97-B(5): 689–695

  8. Mounet B, Choquet O, Swisser F, et al. Impact of multiple nerves blocks anaesthesia on intraoperative hypotension and mortality in hip fracture surgery intermediate-risk elderly patients: A propensity score-matched comparison with spinal and general anaesthesia. Anaesth Crit Care Pain Med. 2021;40(4): 100924.

    Article  PubMed  Google Scholar 

  9. Brox WT, Chan PH, Cafri G, Inacio MC. Similar mortality with general or regional anesthesia in elderly hip fracture patients. Acta Orthop. 2016;87(2):152–7.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Chu CC, Weng SF, Chen KT, et al. Propensity Score-matched Comparison of Postoperative Adverse Outcomes between Geriatric Patients Given a General or a Neuraxial Anesthetic for Hip Surgery: A Population-based Study. Anesthesiology. 2015;123(1):136–47.

    Article  PubMed  Google Scholar 

  11. Patorno E, Neuman MD, Schneeweiss S, Mogun H, Bateman BT. Comparative safety of anesthetic type for hip fracture surgery in adults: retrospective cohort study. BMJ. 2014;348: g4022.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Fields AC, Dieterich JD, Buterbaugh K, Moucha CS. Short-term complications in hip fracture surgery using spinal versus general anaesthesia. Injury. 2015;46(4):719–23.

    Article  PubMed  Google Scholar 

  13. Heidari SM, Soltani H, Hashemi SJ, Talakoub R, Soleimani B. Comparative study of two anesthesia methods according to postoperative complications and one month mortality rate in the candidates of hip surgery. J Res Med Sci. 2011;16(3):323–30.

    PubMed  PubMed Central  Google Scholar 

  14. Helwani MA, Avidan MS, Ben Abdallah A, et al. Effects of regional versus general anesthesia on outcomes after total hip arthroplasty: a retrospective propensity-matched cohort study. J Bone Joint Surg Am. 2015;97(3):186–93.

    Article  PubMed  Google Scholar 

  15. Le-Wendling L, Bihorac A, Baslanti TO, et al. Regional anesthesia as compared with general anesthesia for surgery in geriatric patients with hip fracture: does it decrease morbidity, mortality, and health care costs? Results of a single-centered study. Pain Med. 2012;13(7):948–56.

    Article  PubMed  Google Scholar 

  16. Neuman MD, Silber JH, Elkassabany NM, Ludwig JM, Fleisher LA. Comparative effectiveness of regional versus general anesthesia for hip fracture surgery in adults. Anesthesiology. 2012;117(1):72–92.

    Article  CAS  PubMed  Google Scholar 

  17. Neuman MD, Rosenbaum PR, Ludwig JM, Zubizarreta JR, Silber JH. Anesthesia technique, mortality, and length of stay after hip fracture surgery. JAMA. 2014;311(24):2508–17.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Parker MJ, Griffiths R. General versus regional anaesthesia for hip fractures.  A pilot randomised controlled trial of 322 patients. Injury. 2015;46(8):1562–6.

    Article  PubMed  Google Scholar 

  19. Radcliff TA, Henderson WG, Stoner TJ, Khuri SF, Dohm M, Hutt E. Patient risk factors, operative care, and outcomes among older community-dwelling male veterans with hip fracture. J Bone Joint Surg Am. 2008;90(1):34–42.

    Article  PubMed  Google Scholar 

  20. Seitz DP, Gill SS, Bell CM, et al. Postoperative medical complications associated with anesthesia in older adults with dementia. J Am Geriatr Soc. 2014;62(11):2102–9.

    Article  PubMed  Google Scholar 

  21. Shih JY, Hsieh CH, Kang TW, et al. General versus spinal anesthesia: which is a risk factor for octogenarian hip fracture repair patients? Int J Gerontol. 2010;4:37–42.

    Article  Google Scholar 

  22. Tung YC, Hsu YH, Chang GM. The Effect of Anesthetic Type on Outcomes of Hip Fracture Surgery: A Nationwide Population-Based Study. Medicine (Baltimore). 2016;95(14): e3296.

    Article  CAS  PubMed  Google Scholar 

  23. White SM, Moppett IK, Griffiths R. Outcome by mode of anaesthesia for hip fracture surgery. An observational audit of 65 535 patients in a national dataset. Anaesthesia. 2014;69(3):224–30.

    Article  CAS  PubMed  Google Scholar 

  24. White SM, Moppett IK, Griffiths R, et al. Secondary analysis of outcomes after 11,085 hip fracture operations from the prospective UK Anaesthesia Sprint Audit of Practice (ASAP-2). Anaesthesia. 2016;71(5):506–14.

    Article  CAS  PubMed  Google Scholar 

  25. Wood RJ, White SM. Anaesthesia for 1131 patients undergoing proximal femoral fracture repair: a retrospective, observational study of effects on blood pressure, fluid administration and perioperative anaemia. Anaesthesia. 2011;66(11):1017–22.

    Article  CAS  PubMed  Google Scholar 

  26. Bowden J, Tierney JF, Copas AJ, Burdett S. Quantifying, displaying and accounting for heterogeneity in the meta-analysis of RCTs using standard and generalised Q statistics. BMC Med Res Methodol. 2011;11:41.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Higgins JP, Altman DG, Gotzsche PC, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ. 2011; 343

  28. Sterne JA, Hernán MA, Reeves BC, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016; 355

  29. Luger TJ, Kammerlander C, Gosch M, et al. Neuroaxial versus general anaesthesia in geriatric patients for hip fracture surgery: does it matter? Osteoporos Int. 2010;21(Suppl 4):S555–72.

    Article  CAS  PubMed  Google Scholar 

  30. Guay J, Parker MJ, Gajendragadkar PR, Kopp S. Anaesthesia for hip fracture surgery in adults. Cochrane Database Syst Rev. 2016;2(2):CD000521.

    PubMed  Google Scholar 

  31. Van Waesberghe J, Stevanovic A, Rossaint R, Coburn M. General vs. neuraxial anaesthesia in hip fracture patients: a systematic review and meta-analysis. BMC Anesthesiol. 2017; 17(1): 87

  32. O’Donnell CM, McLoughlin L, Patterson CC, et al. Perioperative outcomes in the context of mode of anaesthesia for patients undergoing hip fracture surgery: systematic review and meta-analysis Br J Anaesth. 2018;120(1):37–50.

    CAS  PubMed  Google Scholar 

  33. Ilango S, Pulle RC, Bell J, Kuys SS. General versus spinal anaesthesia and postoperative delirium in an orthogeriatric population. Australas J Ageing. 2016;35(1):42–7.

    Article  PubMed  Google Scholar 

  34. Chan AW, Tetzlaff JM, Altman DG, et al. SPIRIT 2013 statement: defining standard protocol items for clinical trials. Ann Intern Med. 2013;158(3):200–7.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We wish to thank Haibiao Xie for his suggestions.

Funding

Not applicable.

Author information

Author notes

  1. Bo Ma and Haibiao Xie contributed equally to this work.

Authors and Affiliations

  1. Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, People’s Republic of China

    Bo Ma, Huayong Ling & Wuhua Ma

  2. Department of Urology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, People’s Republic of China

    Haibiao Xie

Authors
  1. Bo Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Haibiao Xie
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Huayong Ling
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wuhua Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

The literature search and data extraction were performed by Bo Ma, Haibiao Xie, and Huayong Ling. Bo Ma drafted the manuscript. Wuhua Ma supervised the project. All authors have read and agreed to the final version of the manuscript.

Corresponding author

Correspondence to Wuhua Ma.

Ethics declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Additional file 1.

  Detail literature search strategies in PubMed, OvidMedline, Cochrane Library and Scopusdatabases.

Additional file 2.

 Cochrane collaboration risk of bias for randomized controlled studies.

Additional file 3

. Cochrane collaboration risk of bias for retrospective observationalstudies.

Additional file 4

. Sensitivity analyses showing pooled effect estimatesfor (A) In-hospital mortality, (B) 30-day hospital mortality, (C) Pneumonia, (D) Delirium when comparing general anesthesia with regional anesthesia.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ma, B., Xie, H., Ling, H. et al. Perioperative outcomes in different anesthesia techniques for patients undergoing hip fracture surgery: a systematic review and meta-analysis. BMC Anesthesiol 23, 184 (2023). https://0-doi-org.brum.beds.ac.uk/10.1186/s12871-023-02150-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://0-doi-org.brum.beds.ac.uk/10.1186/s12871-023-02150-9

Keywords

BMC Anesthesiology

ISSN: 1471-2253

Contact us