The impact of regional versus general anesthesia on postoperative neurocognitive outcomes in elderly patients undergoing hip fracture surgery: a systematic review and meta-analysis

Review question / Objective: To investigate the prevalence of postoperative delirium (POD) or postoperative cognitive dysfunction (POCD) between regional and general anesthesia in older patients undergoing hip fracture surgery. Condition being studied: About 1.6 million people suffer hip fractures each year globally1. The risk of hip fracture-related postoperative mortality within 30 days approximately was 8.2% in December 2020, up 1.5% from December 2016. Across the world, the aging population is growing, and a significant number of elderly patients are undergoing various kinds of orthopedic surgeries. Age as an important independent high-risk factor is associated with perioperative neurocognitive disorders (PNDs), which not only increases the rate but also causes a serious economic and social burden. One previous study investigated that between 2012 and 2016, the absolute total number of hip fractures in people aged 55 and older increased by about 4 times due to an aging population12. In addition, Bhushan et al. reported that along with the increasing aging of society, the incidence rate of POCD is 5% to 56% in the elderly over 55 years old after surgery morbidity and mortality but also causes a serious economic and social burden.