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 E. 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 A. Hymes, Ki‐Jinn Chin, Richard Sheppard, Barry B. Perlman, Joshua W. Sappenfield, Ellen Hauck, Mark A. Hoeft, Jason Karlawish, Samir Mehta, Derek J. Donegan, Annamarie D. Horan, Susan S. Ellenberg, Mark D. Neuman, the REGAIN (Regional versus General Anesthesia for Promoting Independence after Hip Fracture) Investigators
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.