Long-term Outcomes with Spinal versus General Anesthesia for Hip Fracture Surgery: A Randomized Trial

The effects of spinal versus general anesthesia on long-term outcomes have not been well-studied. We tested the hypothesis that spinal anesthesia is associated with better long-term survival and functional recovery than general anesthesia.We conducted a pre-specified analysis of long-term outcomes of a completed randomized superiority trial that compared spinal anesthesia versus general anesthesia for hip fracture repair. Participants included previously ambulatory patients 50 years of age or older at 46 US and Canadian hospitals. Patients were randomized 1:1 to spinal or general anesthesia, stratified by sex, fracture type, and study site. Outcome assessors and investigators involved in the data analysis were masked to the treatment arm. Outcomes included survival at up to 365 days after randomization (primary); recovery of ambulation among 365-day survivors; and composite endpoints for death or new inability to ambulate and death or new nursing home residence at 365 days. Patients were included in the analysis as randomized.1,600 patients were enrolled between February 12, 2016, and February 18, 2021; 795 were assigned to spinal anesthesia, and 805 were assigned to general anesthesia. Among 1,599 patients who underwent surgery, vital status information at or beyond the final study interview (conducted at approximately 365 days after randomization) was available for 1,427 (89.2%). Survival did not differ by treatment arm; at 365 days after randomization, there were 98 deaths in patients assigned to spinal anesthesia versus 92 deaths in patients assigned to general anesthesia (hazard ratio: 1.08; 95% confidence interval (CI): 0.81, 1.44, P=0.59). Recovery of ambulation among patients who survived a year did not differ by type of anesthesia (adjusted odds ratio, spinal vs. general: 0.87; 95% CI: 0.67, 1.14, P=0.31). Other outcomes did not differ by treatment arm.Long-term outcomes were similar with spinal versus general anesthesia.