Abstract
Background
We conducted a systematic review and meta-analysis of contemporary RCTs to determine the clinical effectiveness of spinal vs general anaesthesia (SA vs GA) in patients undergoing hip fracture surgery using a consensus-based core outcome set, and outcomes defined as important by patient and public involvement (PPI) initiatives.
Methods
RCTs comparing any of the core outcomes (mortality, time from injury to surgery, acute coronary syndrome, hypotension, acute kidney injury, delirium, pneumonia, orthogeriatric input, being out of bed at day 1 postoperatively, and pain) or PPI-defined outcomes (return to preoperative residence, quality of life, and mobility status) between SA and GA were identified from MEDLINE, Embase, Cochrane Library, and Web of Science (2000 to February 2022). Pooled relative risks (RRs) and mean differences (95% confidence intervals [CIs]) were estimated.
Results
There was no significant difference in the risk of delirium comparing SA vs GA (RR=1.07; 95% CI, 0.90–1.29). Comparing SA vs GA, the RR for mortality was 0.56 (95% CI, 0.22–1.44) in-hospital, 1.07 (95% CI, 0.52–2.23) at 30 days, and 1.08 (95% CI, 0.55–2.12) at 90 days. Spinal anaesthesia reduced the risk of acute kidney injury compared with GA: RR=0.59 (95% CI, 0.39–0.89). There were no significant differences in the risk of other outcomes. Few studies reported PPI-defined outcomes, with most studies reporting on one to three core outcomes
Conclusions
Except for acute kidney injury, there were no differences between SA and GA in hip fracture surgery when using a consensus-based core outcome set and patient and public involvement-defined outcomes. Most studies reported limited outcomes from the core outcome set, and few reported outcomes important to patients, which should be considered when designing future RCTs.
We conducted a systematic review and meta-analysis of contemporary RCTs to determine the clinical effectiveness of spinal vs general anaesthesia (SA vs GA) in patients undergoing hip fracture surgery using a consensus-based core outcome set, and outcomes defined as important by patient and public involvement (PPI) initiatives.
Methods
RCTs comparing any of the core outcomes (mortality, time from injury to surgery, acute coronary syndrome, hypotension, acute kidney injury, delirium, pneumonia, orthogeriatric input, being out of bed at day 1 postoperatively, and pain) or PPI-defined outcomes (return to preoperative residence, quality of life, and mobility status) between SA and GA were identified from MEDLINE, Embase, Cochrane Library, and Web of Science (2000 to February 2022). Pooled relative risks (RRs) and mean differences (95% confidence intervals [CIs]) were estimated.
Results
There was no significant difference in the risk of delirium comparing SA vs GA (RR=1.07; 95% CI, 0.90–1.29). Comparing SA vs GA, the RR for mortality was 0.56 (95% CI, 0.22–1.44) in-hospital, 1.07 (95% CI, 0.52–2.23) at 30 days, and 1.08 (95% CI, 0.55–2.12) at 90 days. Spinal anaesthesia reduced the risk of acute kidney injury compared with GA: RR=0.59 (95% CI, 0.39–0.89). There were no significant differences in the risk of other outcomes. Few studies reported PPI-defined outcomes, with most studies reporting on one to three core outcomes
Conclusions
Except for acute kidney injury, there were no differences between SA and GA in hip fracture surgery when using a consensus-based core outcome set and patient and public involvement-defined outcomes. Most studies reported limited outcomes from the core outcome set, and few reported outcomes important to patients, which should be considered when designing future RCTs.
| Original language | English |
|---|---|
| Pages (from-to) | 788-800 |
| Number of pages | 13 |
| Journal | British Journal of Anaesthesia |
| Volume | 129 |
| Issue number | 5 |
| DOIs | |
| Publication status | Published - 28 Sept 2022 |
Bibliographical note
Funding Information:Academy of Medical Sciences, the Wellcome Trust, the Medical Research Council, the British Heart Foundation, Versus Arthritis, Diabetes UK, the British Thoracic Society (Helen and Andrew Douglas bequest), and the Association of Physicians of Great Britain and Ireland (SGL023∖1021 to GSM). NIHR Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust and the University of Bristol.
Publisher Copyright:
© 2022 The Author(s)