Original Investigation December 20, 2021<\/p>\n\n\n\n
Effect of Regional vs General Anesthesia on Incidence of Postoperative Delirium in Older Patients Undergoing Hip Fracture Surgery: The RAGA Randomized Trial<\/h1>\n\n\n\n
Ting\u00a0Li,\u00a0Jun\u00a0Li,\u00a0Liyong\u00a0Yuan, et al<\/h3>\n\n\n\n
JAMA.\u00a0<\/em>Published online December 20, 2021. doi:10.1001\/jama.2021.22647<\/h3>\n\n\n\n
Abstract<\/p>\n\n\n\n
Importance<\/strong> In adults undergoing hip fracture surgery, regional anesthesia may reduce postoperative delirium, but there is uncertainty about its effectiveness.<\/p>\n\n\n\n
Objective<\/strong> To investigate, in older adults undergoing surgical repair for hip fracture, the effects of regional anesthesia on the incidence of postoperative delirium compared with general anesthesia.<\/p>\n\n\n\n
Design, Setting, and Participants<\/strong> A randomized, allocation-concealed, open-label, multicenter clinical trial of 950 patients, aged 65 years and older, with or without preexisting dementia, and a fragility hip fracture requiring surgical repair from 9 university teaching hospitals in Southeastern China. Participants were enrolled between October 2014 and September 2018; 30-day follow-up ended November 2018.<\/p>\n\n\n\n
Interventions<\/strong> Patients were randomized to receive either regional anesthesia (spinal, epidural, or both techniques combined with no sedation; n\u2009=\u2009476) or general anesthesia (intravenous, inhalational, or combined anesthetic agents; n\u2009=\u2009474).<\/p>\n\n\n\n
Main Outcomes and Measures<\/strong> Primary outcome was incidence of delirium during the first 7 postoperative days. Secondary outcomes analyzed in this article include delirium severity, duration, and subtype; postoperative pain score; length of hospitalization; 30-day all-cause mortality; and complications.<\/p>\n\n\n\n
Results<\/strong> Among 950 randomized patients (mean age, 76.5 years; 247 [26.8%] male), 941 were evaluable for the primary outcome (6 canceled surgery and 3 withdrew consent). Postoperative delirium occurred in 29 (6.2%) in the regional anesthesia group vs 24 (5.1%) in the general anesthesia group (unadjusted risk difference [RD], 1.1%; 95% CI, \u20131.7% to 3.8%; P<\/em>\u2009=\u2009.48; unadjusted relative risk [RR], 1.2 [95% CI, 0.7 to 2.0]; P<\/em>\u2009=\u2009.57]). Mean severity score of delirium was 23.0 vs 24.1, respectively (unadjusted difference, \u20131.1; 95% CI, \u20134.6 to 3.1). A single delirium episode occurred in 16 (3.4%) vs 10 (2.1%) (unadjusted RD, 1.1%; 95% CI, \u20131.7% to 3.9%; RR, 1.6 [95% CI, 0.7 to 3.5]). Hypoactive subtype in 11 (37.9%) vs 5 (20.8%) (RD, 11.5; 95% CI, \u201311.0% to 35.7%; RR, 2.2 [95% CI, 0.8 to 6.3]). Median worst pain score was 0 (IQR, 0 to 20) vs 0 (IQR, 0 to 10) (difference 0; 95% CI, 0 to 0). Median length of hospitalization was 7 days (IQR, 5 to 10) vs 7 days (IQR, 6 to 10) (difference 0; 95% CI, 0 to 0). Death occurred in 8 (1.7%) vs 4 (0.9%) (unadjusted RD, \u20130.8%; 95% CI, \u20132.2% to 0.7%; RR, 2.0 [95% CI, 0.6 to 6.5]). Adverse events were reported in 106 episodes in the regional anesthesia group and 102 in the general anesthesia group; the most frequently reported adverse events were nausea and vomiting (47 [44.3%] vs 34 [33.3%]) and postoperative hypotension (13 [12.3%] vs 10 [9.8%]).<\/p>\n\n\n\n<\/figure>\n\n\n\n
Conclusions and Relevance<\/strong> In patients aged 65 years and older undergoing hip fracture surgery, regional anesthesia without sedation did not significantly reduce the incidence of postoperative delirium compared with general anesthesia.<\/p>\n\n\n\n
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