Comparing the clinical efficacy and safety of lumbar anesthesia with general anesthesia in patients undergoing hip fracture surgery: a systematic review and meta-analysis of randomized controlled trials

Click on the blue word Follow us

Autumn Equinox

Comparing the clinical efficacy and safety of lumbar anaesthesia versus general anaesthesia in patients undergoing hip fracture surgery using a consensus-based core outcome set and patient- and public-informed outcomes: a systematic review and meta-analysis of randomized controlled trials

Clinical effectiveness and safety of spinal anaesthesia compared with general anaesthesia in patients undergoing hip fracture surgery using a consensus-based core outcome set and patient-and public-informed outcomes: a systematic review and meta-analysis of randomised controlled trials

Comparing the clinical efficacy and safety of lumbar anaesthesia with general anaesthesia in patients undergoing hip fracture surgery using a consensus-based core outcome set and patient- and publicly informed outcomes: a systematic review and meta-analysis of randomised controlled trials

1

Background

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.

Background: We conducted a systematic review and meta-analysis of randomised controlled trials to determine the clinical effectiveness
of lumbar anesthesia with general anaesthesia (SA vs GA) in people undergoing hip fracture surgery, using a consensus-based core outcome set and patient and public participation (PPI) initiatives defining important outcomes.

2

Methods

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.

Methods: To compare any of the core outcomes RCTs (mortality, time from injury to surgery, acute coronary syndrome, hypotension, acute kidney injury, delirium, pneumonia, geriatric syndrome, ambulation and pain on day 1 after surgery) or PPI-defined outcomes to determine differences between SA and GA (return to preoperative residence, quality of life, and activity status) from MEDLINE, Embase, Cochrane Library, and Web of Science (2000 to February 2022).

Estimated pooled relative risk (RR) and mean difference (95% confidence interval [CI]).

3

Results

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.

Result: There was no significant difference in the risk of delirium between the SA and GA groups (RR = 1.
07; When SA and GA were compared, the RR for mortality during hospital stay was 0.
56 (95% CI, 0.
22 to 1.
44), 1.
07 (95% CI, 0.
52 to 2.
23) at 30 days, and 1.
08 (95% CI, 0.
90 to 1.
29)
at 30 days.
0.
55-2.
12）
。 Spinal anaesthesia reduced the risk of acute kidney injury compared to GA: RR = 0.
59 (95% CI, 0.
39 to 0.
89), no significant difference in risk for other outcomes, few studies reporting PPI-defined outcomes, most reported 1 to 3 core outcomes
.

2

Conclusions:

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.

Conclusions: With the exception of acute kidney injury, there was no difference between SA and GA in hip fracture surgery when using consensus-based core outcome sets and patient- and public participation-defined outcomes, most studies reported limited core outcome set outcomes and few patient-important outcomes that should be considered when designing future RCTs
.

3

Keywords

Keywords: complication; core outcome set; general anaesthesia; hip fracture; meta-analysis; mortality; spinal anaesthesia; systematic review.

Keywords: complications; core results set; General anesthesia; hip fracture; meta-analysis; Mortality; Spinal anesthesia; Systematic review
.

Results show:

Figure 1.
PRISMA flowchart
.

Fig.
2 Risk of
delirium compared to general anesthesia for lumbar anesthesia.

Fig.
3 Risk of hypotension in lumbar anesthesia compared with general anesthesia

Fig.
4 Mortality rate of lumbar anesthesia compared with general anesthesia

Fig.
5 Lumbar anesthesia compared with general anesthesia compared with the risk of
acute coronary syndrome.

Comparing the clinical efficacy and safety of lumbar anaesthesia with general anaesthesia in patients undergoing hip fracture surgery using a consensus-based core outcome set and patient- and public-informed outcomes: a systematic review and meta-analysis .
pdf randomised controlled trials

Article | Riozhou

Typography | meat