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Comparing perioperative outcomes between regional anesthesia and general anesthesia in patients undergoing hip fracture surgery: a systematic review and meta-analysis

Comparaison des issues périopératoires entre l’anesthésie régionale et l’anesthésie générale chez la patientèle bénéficiant d’une chirurgie de fracture de la hanche : une revue systématique et une méta-analyse

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Abstract

Purpose

Nearly all patients with hip fractures undergo surgical treatment. The use of different anesthesia techniques during surgery may influence the clinical outcomes. The optimal anesthetic technique for patients undergoing hip fracture surgery is still controversial. We performed this updated systematic review and meta-analysis to compare clinical outcomes of patients undergoing hip fracture surgery with different anesthesia techniques.

Source

Articles published from 2000 to May 2023 were included from MEDLINE, Embase, Web of Science, and the Cochrane Library. We included randomized controlled trials and observational studies comparing general anesthesia (GA) with regional anesthesia (RA) for the outcomes of 30-day mortality, 90-day mortality, in-hospital mortality, perioperative complications, length of hospital stay, and length of surgery in patients undergoing hip fracture surgery. Subgroup analyses were performed for the outcomes based on study design (randomized controlled trials or observational studies). We used a random-effects model for all analyses.

Principal findings

In this meta-analysis, we included 12 randomized controlled trials. There was no difference in postoperative 30-day mortality between the two groups (odds ratio [OR], 0.88; 95% confidence interval [CI], 0.44 to 1.74; I2 = 0%). The incidence of intraoperative hypotension was lower in patients who received RA vs GA (OR, 0.52; 95% CI, 0.38 to 0.72; I2 = 0%). No significant differences were observed in 90-day mortality, in-hospital mortality, postoperative delirium, pneumonia, myocardial infarction, venous thromboembolism, length of surgery, and length of hospital stay.

Conclusion

In this updated systematic review and meta-analysis, RA did not reduce postoperative 30-day mortality in hip fracture surgery patients compared to GA. Fewer patients receiving RA had intraoperative hypotension than those receiving GA did. Apart from intraoperative hypotension, the data showed no differences in complications between the two anesthetic techniques.

Study registration

PROSPERO (CRD42023411854); registered 7 April 2023.

Résumé

Objectif

Presque toutes les personnes ayant subi une fracture de la hanche se font opérer. L’utilisation de différentes techniques d’anesthésie pendant la chirurgie peut influencer les issues cliniques. La technique d’anesthésie optimale pour la patientèle bénéficiant de chirurgie de fracture de la hanche est encore controversée. Nous avons réalisé cette mise à jour par revue systématique et méta-analyse pour comparer les issues cliniques des personnes bénéficiant d’une chirurgie de fracture de la hanche avec différentes techniques d’anesthésie.

Sources

Les articles publiés de 2000 à mai 2023 ont été inclus à partir des bases de données MEDLINE, Embase, Web of Science et Cochrane Library. Nous avons inclus des études randomisées contrôlées et des études observationnelles comparant l’anesthésie générale (AG) à l’anesthésie régionale (AR) pour les issues de mortalité à 30 jours, de mortalité à 90 jours, de mortalité intrahospitalière, de complications périopératoires, de durée de séjour à l’hôpital et de durée de la chirurgie pour les personnes bénéficiant d’une chirurgie de fracture de la hanche. Des analyses de sous-groupes ont été réalisées pour les issues en fonction de la méthodologie utilisée (étude randomisée contrôlée ou étude observationnelle). Un modèle à effets aléatoires a été utilisé pour toutes les analyses.

Constatations principales

Dans cette méta-analyse, nous avons inclus 12 études randomisées contrôlées. Il n’y avait pas de différence dans la mortalité postopératoire à 30 jours entre les deux groupes (rapport de cotes [RC], 0,88; intervalle de confiance à 95 % [IC], 0,44 à 1,74; I2 = 0 %). L’incidence d’hypotension peropératoire était plus faible chez les patient·es ayant reçu une AR vs une AG (RC, 0,52; IC 95 %, 0,38 à 0,72; I2 = 0 %). Aucune différence significative n’a été observée dans les issues de mortalité à 90 jours, de mortalité intrahospitalière, de delirium postopératoire, de pneumonie, d’infarctus du myocarde, de thromboembolie veineuse, de durée de la chirurgie, et de durée du séjour à l’hôpital.

Conclusion

Dans cette revue systématique avec méta-analyse, l’anesthésie régionale n’a pas réduit la mortalité postopératoire à 30 jours chez les personnes ayant bénéficié d’une chirurgie de fracture de la hanche par rapport à l’anesthésie générale. Une proportion moindre de patient·es ayant reçu une AR présentaient une hypotension peropératoire par rapport aux personnes ayant reçu une AG. En dehors de l’hypotension peropératoire, les données n’ont montré aucune différence dans les complications entre les deux techniques anesthésiques.

Enregistrement de l’étude

PROSPERO (CRD42023411854); enregistrée le 7 avril 2023.

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Author contributions

All authors participated in designing and conceiving the study. Song Liu and Jianan Chen performed the literature search. Wenjun Hu and Gang Zeng extracted information from the literature, which was independently checked by Wenzhou Liu, Jianhong Li. Song Liu, Jianan Chen, and Huihong Shi contributed to data analysis. All authors contributed to data interpretation. Song Liu, Jianan Chen, and Huihong Shi contributed to drafting the manuscript, and Yanbo Chen, Wenjie Gao, Anjing Liang, and Weidong Song contributed to critically reviewing and editing it.

Disclosures

None.

Funding statement

This study was supported by Medical Research Foundation of Guangdong Province (A2021280), Sun Yat-sen Clinical Research Cultivation Program (SYS-Q-202105) and Sun Yat-sen Scientific Research Project (YXQH202213).

Editorial responsibility

This submission was handled by Dr. Vishal Uppal, Associate Editor, Canadian Journal of Anesthesia/Journal canadien d’anesthésie.

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Author notes

  1. Song Liu, Jianan Chen, and Huihong Shi have contributed equally to this work and are co-first authors.

Authors and Affiliations

  1. Department of Orthopedics, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China

    Song Liu MM, Jianan Chen MM, Huihong Shi MM, Jianhong Li MB, Gang Zeng MD, Wenzhou Liu MD, Wenjun Hu MM, Shaoguang Li MM, Wenjie Gao MD, Weidong Song MD & Anjing Liang MD

  2. Department of Orthopedics, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Yingfeng Road, 33th Haizhu District, Guangzhou, 510000, China

    Yanbo Chen MD

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Liu, S., Chen, J., Shi, H. et al. Comparing perioperative outcomes between regional anesthesia and general anesthesia in patients undergoing hip fracture surgery: a systematic review and meta-analysis. Can J Anesth/J Can Anesth (2024). https://doi.org/10.1007/s12630-024-02696-3

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