Influence of spinal anesthesia versus general anesthesia on postoperative delirium in patients with hip fractures: A systematic review and meta-analysis.

BACKGROUND

Anesthesia type for hip fracture surgery and its relation to postoperative delirium (POD) is a topic of ongoing debate. This study aimed to elucidate whether there is a significant difference in POD incidence, mortality, and length of hospital stay between general anesthesia (GA) and spinal anesthesia (SA).

METHODS

We conducted a systematic review and meta-analysis of randomized controlled trials that compared the outcomes of GA and SA in hip fracture surgeries, adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data was extracted from 4 databases: PubMed, Embase, Web of Science, and the Cochrane Library. The main outcome of interest was the incidence of POD, with secondary outcomes including length of hospital stay and mortality rate.

RESULTS

The initial database search yielded 1012 studies, 9 of which met inclusion criteria and were included in the meta-analysis. There was no significant difference in the incidence of POD at postoperative day 4 (RR = 1.03, 95% CI: 0.85-1.25, P > .05) or day 7 (RR = 1.05, 95% CI: 0.89-1.25, P > .05) between GA and SA groups. The mortality rate at 3 months post-surgery (RR = 1.02, 95% CI: 0.69-1.50, P > .05) and total hospital stay duration (MD = -0.04, 95% CI: -0.17 to 0.08, P > .05) also did not significantly differ between the 2 groups.

CONCLUSION

Although SA has certain advantages over GA, no significant difference was observed in the incidence of postoperative delirium, mortality, and hospital stay length between the 2 methods.