The impact of regional versus general anesthesia on postoperative neurocognitive outcomes in elderly patients undergoing hip fracture surgery: A systematic review and meta-analysis.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of randomized controlled trials
PubMed 36031067 · doi:10.1016/j.ijsu.2022.106854
What was done
A systematic review and meta-analysis of randomized controlled trials searched PubMed, Cochrane Library, Embase, and Web of Science through June 2022. The study compared regional anesthesia to general anesthesia in elderly patients (aged >65 years) undergoing hip fracture surgery. Primary outcomes were the incidence of postoperative delirium (POD) or postoperative cognitive dysfunction (POCD) at 24 hours, 3 days, and 7 days. Secondary outcomes were 30-day mortality rate and other adverse events. Risk of bias was assessed using Cochrane methodology.
What was found
Eight studies with 3,555 elderly patients were included. There was no significant difference in the prevalence of POD or POCD between regional and general anesthesia at 24 hours (OR 0.73; 95% CI 0.19, 2.71; I2 = 53%; n = 452; P = 0.63), at 3 days (OR 1.03; 95% CI 0.79, 1.35; I2 = 0%; n = 1,362; P = 0.82), or at 7 days (OR 0.79; 95% CI 0.41, 1.52; I2 = 51%; n = 1,336; P = 0.47). No significant differences were observed in the incidence of other adverse events, and numerical outcomes for secondary endpoints were not reported in the abstract.
Why it matters
This review indicates that choosing regional over general anesthesia does not reduce early postoperative neurocognitive complications in older hip fracture surgery patients. Anesthetic selection can therefore be based on individual patient characteristics rather than an expected reduction in cognitive risk.
Limits
The total number of included trials was small (8 RCTs), with limited patient numbers available at specific time points (such as n = 452 at 24 hours). Moderate statistical heterogeneity was present at 24 hours (I2 = 53%) and 7 days (I2 = 51%). Delirium and cognitive dysfunction were grouped together rather than analyzed as distinct neurocognitive entities, and follow-up was limited to 7 days for cognition with no specific quantitative data reported in the abstract for 30-day mortality.
Cited by
- supports Scientific studies show that a patient's frailty, baseline neurocognitive reserve, and neurological resilience predict post-surgical cognitive outcomes more than the choice between regional or general anesthetic drugs.