Comparing the Effect of Spinal and General Anesthesia for Hip Fracture Surgery in Older Patients: A Meta‐analysis of Randomized Clinical Trials

Hua Lin; Ying Zhu; Cheng Ren; Teng Ma; Ming Li; Zhong Li; Yibo Xu; Qian Wang; Jing Hu; Kun Zhang

doi:10.1111/os.13895

. 2023 Sep 27;15(12):3254–3262. doi: 10.1111/os.13895

Comparing the Effect of Spinal and General Anesthesia for Hip Fracture Surgery in Older Patients: A Meta‐analysis of Randomized Clinical Trials

Hua Lin ¹, Ying Zhu ², Cheng Ren ^1,^✉, Teng Ma ^1,^✉, Ming Li ¹, Zhong Li ¹, Yibo Xu ¹, Qian Wang ¹, Jing Hu ³, Kun Zhang ¹

PMCID: PMC10693995 PMID: 37753546

Abstract

Objective

Hip fractures are the most common fractures among older adults, with most patients undergoing surgery. The debate regarding the type of anesthetic technique for hip fracture surgery is still ongoing. This meta‐analysis aimed to compare the intraoperative and postoperative outcomes of spinal and general anesthesia in older patients undergoing hip fracture surgery.

Methods

Eligible studies that compared the effects of spinal and general anesthesia were systematically searched from PubMed, Embase, and the Cochrane Library until May 27, 2022. The intraoperative and postoperative outcomes of the two anesthesia techniques were compared. Quality assessment, heterogeneity analysis, and publication bias of the studies were also assessed.

Results

Nine articles of methodological quality were included in the meta‐analysis. The pooled results revealed that there were significant differences in hypotension (risk ratio [RR] (95% confidence interval [CI]) = 0.81 (0.68, 0.97), p = 0.02) and ephedrine dose (weighted mean difference [WMD] [95%CI] = −20.94 [−37.50, −4.37] mg, p = 0.01) between the spinal and general anesthesia groups. However, no significant differences were observed in the use of ephedrine (RR [95% CI] = 0.77 [0.19, 3.05]), blood loss (WMD [95%CI] = −34.38 [−89.56, 20.80) mL], myocardial infarction (RR [95% CI] = 0.78 [0.31, 1.94] mL), heart failure (RR [95% CI] = 0.87 [0.17, 4.36] mL), stroke (RR [95%CI) = 0.65 [0.22, 1.95] mL), postoperative nausea and vomiting (RR [95% CI] = 0.88 [0.17, 4.35] mL), delirium (RR [95% CI] = 1.08 [0.89, 1.31] mL), and mortality (RR [95% CI] = 1.10 [0.72, 1.68] mL) (all p < 0.05). No publication bias was observed in any of the included studies.

Conclusion

Compared to general anesthesia, spinal anesthesia was associated with a lower risk of intraoperative hypotension and lower doses of ephedrine in older patients undergoing hip fracture surgery.

Keywords: Ephedrine, Hypotension, Intraoperative outcomes, Older population, Postoperative outcomes

Flow chart of study selection.

graphic file with name OS-15-3254-g003.jpg

Introduction

Hip fractures are a major public health problem that occurs in approximately 1.6 million people annually worldwide. ¹ With an aging population, the incidence of hip fractures is increasing worldwide, causing a huge challenge and burden to patients and healthcare systems. ² Because the patient population consists of older people with various underlying medical conditions, most hip fractures are complicated. It has been reported that in Europe and the USA, the mortality rate after hip fracture is between 4% and 12% after 1 month and up to 35% after 1 year. ³ Owing to high morbidity and mortality rates, most people with hip fractures require hospital admission and surgical management. ⁴ , ⁵ , ⁶ Both neuraxial (epidural/spinal) and general anesthesia are valid options for hip fracture surgery. However, there is still debate regarding which anesthesia technique for hip fracture surgery offers better outcomes in older patients. ⁷ , ⁸ A previous meta‐analysis of randomized controlled trials (RCTs) compared the efficacy of two anesthesia techniques for hip fracture surgery; however, the number of included studies was small, and there was insufficient evidence to suggest a statistically significant difference in most outcomes. ⁹ Further studies are required to clarify this issue.

Recently, several RCTs have been conducted to compare the efficacy of the two anesthesia techniques for hip fracture surgery. For instance, Li et al. reported that in older patients with hip fractures, regional anesthesia without sedation and general anesthesia had a similar incidence of postoperative delirium. ¹⁰ Neuman et al. revealed that spinal and general anesthesia did not show significant differences in survival, recovery of ambulation at 60 days, and postoperative delirium incidence in patients with hip fracture. ¹¹ Therefore, this study conducted a meta‐analysis of RCTs reporting the effects of spinal and general anesthesia in older patients undergoing hip fracture surgery, aiming to systematically evaluate the intraoperative and postoperative outcomes of the two anesthesia techniques.

Material and Methods

Search Strategy

This meta‐analysis was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐analyses (PRISMA) guidelines.

Using a pre‐established search strategy, eligible studies were searched systematically from PubMed, Embase, and the Cochrane Library. The following search terms were used: (i) “hip fracture,” “femoral neck fracture,” “transcervical fracture,” “intertrochanteric femoral fractures,” and “subtrochanteric femur fractures”; (ii) “spinal anesthesia,” “neuraxial anesthesia,” “epidural anesthesia,” and “regional anesthesia;” and (3) “randomized controlled trial,” “controlled clinical trial,” and “randomly.” The search terms of the same category were combined with “OR,” and those of different categories were combined with “AND.” The search steps were determined according to database characteristics (Tables [Link], [Link]). The search was conducted on May 27, 2022, and all eligible articles included in these databases were collected up to that date. There was no language restriction. Moreover, relevant reviews and reference lists of the included articles were manually searched to obtain more studies.

Inclusion and Exclusion Criteria

Study selection was conducted based on the following inclusion criteria: (i) the subjects were older patients aged ≥60 years with hip fractures; (ii) the differences in spinal and general anesthesia were compared; (iii) an RCT was included; and (iv) one or more of the following outcomes were reported—intraoperative outcomes, such as hypotension, use of ephedrine, ephedrine dose, and blood loss; and postoperative outcomes, such as myocardial infarction (MI), heart failure (HF), stroke, postoperative nausea and vomiting (PONV), delirium, and mortality.

The exclusion criteria were as follows: (i) non‐authoritative studies, such as conference abstracts, reviews, and comments; and (ii) only the study with the most complete information was included for the repeated publications or the same data used in multiple articles.

Data Extraction

Two investigators independently screened the relevant literature. Based on a pre‐designed standardized form, the following data were extracted: first author, publication year, study area, fracture type, operation type, anesthesia group (sample size, age, sex, and American Society of Anesthesiologists [ASA] physical status), delay in surgery, operation time, and outcome indicators. The primary outcomes were the intraoperative outcomes of two anesthesia techniques, including hypotension, ephedrine use, ephedrine dose, and blood loss. The secondary outcomes were postoperative outcomes including MI, HF, stroke, PONV, delirium, and mortality. After the data extraction, the two investigators exchanged the audit extraction form. Disagreements were settled through discussions.

Quality Assessment

The Cochrane Collaboration tool for assessing risk ¹² was used for the quality assessment of RCTs.

Statistical Analysis

To investigate the difference in outcomes between the spinal and general anesthesia groups, the weighted mean difference (WMD) with 95% confidence interval (CI) was applied for continuous variables, and the risk ratio (RR) with 95% CI was used for categorical variables. Cochran's Q test and I² test were used to assess the heterogeneity among the studies. ¹³ If p < 0.05 and/or I² > 50%, there was significant heterogeneity, and a meta‐analysis was conducted using a random‐effects model. Otherwise, a fixed‐effects model was applied. Publication bias was evaluated using the Egger test. ¹⁴ All statistical analyses were performed using Stata12.0 software (Stata Corp, College Station, TX, USA) and RevMan 5.3 software (RevMan, Copenhagen, Denmark).

Results

Study Selection

A flow chart of the study selection process is displayed in Figure 1. A total of 1092 articles (PubMed: 381, Embase: 365, and the Cochrane Library: 346) were retrieved through database searching. After eliminating 412 duplicate articles, 680 were preserved. We eliminated 663 articles after browsing the abstracts and titles. After reading the full text, eight articles were removed. In addition, no eligible studies were obtained through a manual search. Finally, nine articles ¹⁰ , ¹¹ , ¹⁵ , ¹⁶ , ¹⁷ , ¹⁸ , ¹⁹ , ²⁰ , ²¹ were included in this meta‐analysis.

Fig. 1 — The flow chart of study selection.

Characteristics of the Included Studies

The characteristics of the nine eligible studies are summarized in Table 1. The sample size of the included studies was 10–1600 cases, with a total of 3022 cases. The research was conducted in China, France, Italy, the USA, Canada, Iran, Korea, and Greece. The ratio of male to female sex, age, ASA status, and delay in surgery were comparable between the spinal and general anesthesia groups. Except for the study by Haghighi et al., ¹⁷ no significant difference was found in the duration of surgery between the spinal and general anesthesia groups in other studies. The fracture and operation types were highly heterogeneous among the studies.

TABLE 1.

Characteristics of 9 included studies in this meta‐analysis.

Study	Surgery type	Type of fracture	Group	n, M/F	Age, years	ASA status	Duration of surgery, min	Delay in surgery
Biboule et al. 2012 (France)	Hip nailing or Hemiarthroplasty	Hip fracture	SA	15, 4/11	87.0 ± 7	10 III/5 IV	36 (25–100) #	3.7 ± 3.8, days
			GA	29, 9/20	85.5 ± 6	18 III/11 IV	46 (22–110) #	3.5 ± 2.7, days
Casati et al. 2003 (Italy)	Hemiarthroplasty	Femur fracture	SA	15, 1/14	84 (71–94) #	6 II/9 III	80 (45–110) #	NR
			GA	15, 1/14	84 (67–88) #	7 II/8 III	75 (50–100) #	NR
Haghighi et al. 2017 (Iran)	NR	Hip fracture	SA	50, 42/8	66.22 ± 5.17	6 I/33 II/11 III	87.24 ± 4.33	NR
			GA	50, 38/12	65.98 ± 4.76	8 I/31 II/11 III	95.68 ± 3.27*	NR
Li et al. 2021 (China)	Closed/Open reduction and internal fixation	Femoral neck, Intertrochanteric, Subtrochanteric, Femoral head	SA	471, 343/128	77 (72, 82) &	22 I/350 II/98 III/1 IV	NR	NR
			GA	471, 352/119	77 (71, 82) &	17 I/363 II/90 III/1 IV	NR	NR
Messina et al. 2013 (Italy)	Hemiarthroplasty	Hip fracture	SA	10, 3/7	81.8 ± 6.3	10 III	NR	27.3 ± 1.5, hours
			GA	10, 4/6	83.9 ± 9.4	10 III	NR	25.7 ± 2.2, hours
Meuret et al. 2018 (France)	Hip nailing, DHS plate, arthroplasty	Hip fracture	SA	19, 2/17	83 ± 6	2 I/8 II/9 III	35 (30, 49) &	1 (1, 3), days &
			GA	21, 6/15	85 ± 5	0 I/10 II/11 III	45 (34, 53) &	1 (1, 3), days &
Neuman et al. 2021 (USA, Canada)	Hemiarthroplasty, Fixation, Total hip arthroplasty	Femoral neck, intertrochanteric, subtrochanteric, other	SA	795, 258/537	77.7 ± 10.7	22 I/229 II/486 III/45 IV	62 (43, 89) &	NR
			GA	805, 270/535	78.4 ± 10.6	18 I/270 II/463 III/42 IV	65 (44, 89) &	NR
Shin et al. 2020 (Korea)	Bipolar hemiarthroplasty or internal fixation	Femoral neck, intertrochanteric, subtrochanteric, other	SA	58, 17/41	81.6 ± 6.7	NR	NR	47.5 (24, 72), hours &
			GA	118, 29/89	79.9 ± 7.2	NR	NR	44.5 (24, 70), hours &
Tzimas et al. 2018 (Greece)	NR	Femur fracture	SA	37, NR	77.11 ± 6.5	0 I/21 II/16 III	57 ± 25	NR
			GA	33, NR	75.09 ± 6.08	2 I/20 II/11 III	56 ± 19	NR

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Note: *, p < 0.05; #, median (range); &, median (interquartile range).

Abbreviations: ASA, American Society of Anesthesiologists; F, female; M, male; NR, not reported; SA, general anesthesia; SA, spinal anesthesia.

Quality Assessment Results

The results of the quality assessment showed moderate methodological quality in the included studies (Figure S1). Among them, four studies ¹⁵ , ¹⁶ , ¹⁷ , ¹⁸ showed an uncertain risk of selection bias, all included studies ¹⁰ , ¹¹ , ¹⁵ , ¹⁶ , ¹⁷ , ¹⁸ , ¹⁹ , ²⁰ , ²¹ exhibited an uncertain risk of performance bias, and five ¹¹ , ¹⁵ , ¹⁷ , ¹⁸ , ¹⁹ studies displayed an uncertain risk of detection bias. Expect for the aforementioned studies with uncertain bias risks, the remaining studies demonstrated a low risk of all biases.

Results of Meta‐analysis

The intraoperative outcomes of different anesthesia techniques in older patients undergoing hip fracture surgery were analyzed. Figure 2A–D shows the difference in hypotension, ephedrine use, ephedrine dose, and blood loss between the spinal and general anesthesia groups. Except for hypotension (I² = 34%, p = 0.02), the other three outcome indicators showed significant heterogeneity (I² > 50%, p < 0.05). The pooled results revealed that there were significant differences in hypotension (RR [95% CI] = 0.81 [0.68, 0.97], p = 0.02, Figure 2A) and dose of ephedrine (WMD (95% CI] = −20.94 [−37.50, −4.37] mg, p = 0.01, Figure 2C) between the spinal and general anesthesia groups, indicating that for older patients with hip fracture, spinal anesthesia had a lower risk of hypotension and a lower dose of ephedrine than general anesthesia.

Fig. 2 — The forest plots of intraoperative outcomes, including hypotension (A), use of ephedrine (B), dose of ephedrine (C), and blood loss (D).

However, no significant difference was observed in the use of ephedrine (RR [95% CI] = 0.77 [0.19, 3.05], p = 0.71) or blood loss (WMD [95% CI] = −34.38 [−89.56, 20.80] mL, p = 0.22) between the spinal and general anesthesia groups.

Figure 3A–F shows the differences in postoperative outcomes, including MI, HF, stroke, PONV, delirium, and mortality, between the spinal and general anesthesia groups. Only the studies reporting PONV showed significant heterogeneity (I² = 70%, p = 0.03). The pooled results revealed that there was no significant difference between the spinal and general anesthesia groups in MI (RR [95% CI] = 0.78 [0.31, 1.94], p = 0.60), HF [RR (95% CI] = 0.87 [0.17, 4.36], P = 0.87), stroke (RR [95% CI] = 0.65 [0.22, 1.95], p = 0.44), PONV (RR [95% CI] = 0.88 [0.17, 4.35), p = 0.87), delirium (RR [95% CI] = 1.08 [0.89, 1.31], p = 0.45), and mortality (RR (95% CI] = 1.10 [0.72, 1.68], p = 0.65).

Fig. 3 — The forest plots of postoperative outcomes, including MI (A), HF (B), stroke (C), PONV (D), delirium (E), and mortality (F). MI, myocardial infarction; HF, heart failure, POVA, postoperative nausea and vomiting.

Publication Bias

The number of eligible studies reporting the use of ephedrine, HF, and stroke was less than three and could not be used for the Egger test. There was no significant publication bias for any other outcome indicators (p > 0.05).

Discussion

Main Findings of this Study

In the present meta‐analysis, nine RCTs were included to systematically compare the effects of spinal and general anesthesia on intraoperative and postoperative outcomes of hip fracture surgery in older patients. Our data showed that spinal anesthesia had a lower risk of intraoperative hypotension (RR [95% CI] = 0.81 [0.68, 0.97], p = 0.02) and a lower dose of ephedrine (WMD [95% CI] = −20.94 [−37.50, −4.37] mg, p = 0.01) than general anesthesia. Other intraoperative and postoperative outcomes did not show significant differences between the spinal and general anesthesia groups.

The Advantages of each Type of Anesthesia

Previous studies have revealed some advantages of each type of anesthesia. Spinal anesthesia has been reported to have some advantages, such as avoidance of airway management and blood loss, reduction of deep venous thrombosis risk, and improvement of postoperative analgesia. ²² , ²³ Conversely, general anesthesia has a faster induction and more stable hemodynamic state. ²⁴ , ²⁵ Several studies have revealed that, compared to general anesthesia, spinal anesthesia is associated with lower risks of some outcomes, such as delirium ²⁶ and major medical complications, ²⁷ whereas some randomized trials have reported conflicting results that there are no differences in outcomes between the two anesthesia techniques. ⁸ Therefore, comprehensive evaluation of perioperative outcomes will provide reliable evidence to select the optimal surgery technique.

Comparison of Intraoperative Hypotension Risk and Ephedrine Dose of Two Anesthesia Techniques

Based on pharmacology, spinal anesthesia may result in a lower heart rate and hypotension relative to general anesthesia by blocking α‐ and β‐adrenergic receptors. ²⁸ Consequently, controlled blood pressure may lead to less intraoperative blood loss in patients receiving spinal anesthesia. ¹⁵ , ²⁹ In a previous meta‐analysis conducted by Zheng et al., ⁹ the combined pooled data revealed a significant difference in blood loss between neuraxial anesthesia and general anesthesia (mean difference [95% CI] = −137.8 [−241.49, −34.12], p = 0.009). However, in this analysis, the authors reversed the data of Messina et al. ¹⁸ in their meta‐analysis of blood loss. The revised pooled results revealed a significant difference between the two groups (WMD [95% CI] = −118.97 [−255.81, 17.86] mL, p = 0.09), which was consistent with the results of our meta‐analysis of blood loss (WMD [95% CI] = −34.38 [−89.56, 20.80] mL, p = 0.22) between the spinal and general anesthesia groups. Another previous meta‐analysis including 21 RCTs has also revealed that there is insufficient evidence to support the effectiveness of neuraxial anesthesia in reducing intraoperative blood loss. ³⁰ In addition, the older population is at high risk of intraoperative hypotension, which is related to postoperative morbidity and mortality in patients undergoing hip fracture surgery. ³¹ , ³² The increased risk of spinal anesthesia‐induced hypotension in older people is due to age‐related cardiovascular changes such as an increase in basal sympathetic activity and a reduction in baroreceptor sensitivity. ³³ Li et al. demonstrated that the risk of intraoperative hypotension was dramatically increased in the general anesthesia group compared to that in the regional anesthesia group. ¹⁰ Ephedrine is a vasoconstrictor for anesthesia‐induced hypotension. ³⁴ Simonin et al. also revealed that severe hypotension was more frequent in the general anesthesia group in relation to the hypobaric unilateral spinal anesthesia group. ³⁵ In this meta‐analysis, we found that spinal anesthesia had a lower risk of intraoperative hypotension and a lower dose of ephedrine than general anesthesia, suggesting that spinal anesthesia is superior to general anesthesia in terms of intraoperative outcomes.

Comparison of the Risk of Postoperative Complications of Two Anesthesia Techniques

Research efforts persistently investigate the efficacy of different anesthesia methods in mitigating the risk of postoperative complications. ²⁰ , ³⁵ A broad spectrum of complications have been investigated following hip fracture surgery, like mortality, delirium, HF, and MI. ³⁶ In a previous meta‐analysis conducted by Zheng et al., ⁹ the prevalence of delirium (OR = 1.05, 95% CI 0.27, 4.00; p = 0.95), and acute MI (OR = 0.88, 95% CI 0.17, 4.65; p = 0.88) had no significant differences between the spinal and general anesthesia groups. Simonin et al. reported that the general anesthesia and hypobaric unilateral spinal anesthesia exhibited comparable postoperative outcomes, such as MI (p = 0.63) and 30‐day mortality (p = 0.65). ³⁵ In line with these findings, our meta‐analysis did not show significant differences in postoperative outcomes, including MI, HF, stroke, PONV, delirium, and mortality, between the spinal and general anesthesia groups. These results hint that two anesthesia techniques are comparable in terms of postoperative outcomes.

Strengths and Limitations of this Study

The present meta‐analysis had several advantages. First, only older patients were enrolled and only RCTs were included, which guaranteed the credibility of the combined results. Second, the included studies exhibited moderate methodological quality, and the risk of bias, including attrition bias and reporting bias, was low, which may have contributed to decreasing systematic bias. Finally, there was no significant publication bias among the studies, indicating that our results were reliable.

The limitations of this meta‐analysis should not be ignored. First, the clinical heterogeneity of some indicators was significant because of the differences in fracture and surgical types; however, the number of included studies was small, and the source of heterogeneity could not be explored via meta‐regression or subgroup analysis. Second, although statistically significant results were obtained for some outcomes, owing to the small number of included studies and large heterogeneity, the extrapolation of the combined results is limited. Further, high‐quality, large‐sample RCTs are required to validate the extrapolation of our results.

Conclusion

This study revealed that spinal anesthesia was associated with a lower risk of intraoperative hypotension and lower doses of ephedrine in older patients undergoing hip fracture surgery than general anesthesia. Although the postoperative complications of the two anesthesia techniques are similar, considering the limited research available and certain heterogeneity, further studies are still needed to explore the influence of anesthesia techniques on perioperative outcomes.

Author Contributions

Cheng Ren and Teng Ma carried out the conception and design of the research, Ming Li and Yibo Xu participated in the acquisition of data. Zhong Li, Qian Wang and Ying Zhu carried out the analysis and interpretation of data. Ying Zhu performed the statistical analysis. Teng Ma and Yibo Xu participated in obtaining funding. Hua Lin conceived of the study, and participated in its design and coordination and drafted the manuscript and Qian Wang, Jing Hu and Kun Zhang conceived of the revision of manuscript for important intellectual content. All authors read and approved the final manuscript.

Conflict of Interest Statement

The authors declare that they have no competing interests.

Supporting information

Figure S1. Quality assessment of the included studies.

Click here for additional data file.^{(2.9MB, tif)}

Figure S2. The forest plots of blood loss based on the included studies in a previous meta‐analysis conducted by Zheng et al.

Click here for additional data file.^{(287.4KB, tif)}

Table S1. The search steps and results of PubMed database.

Click here for additional data file.^{(35KB, doc)}

Table S2. The search steps and results of Embase database.

Click here for additional data file.^{(32KB, doc)}

Table S3. The search steps and results of the Cochrane Library database.

Click here for additional data file.^{(35KB, doc)}

Acknowledgments

This work was supported by Shaanxi Province Natural Science Fundamental Research Project (Program No. 2022JQ‐759) and Shaanxi Province Natural Science Fundamental Research Project (Program No. 2022JQ‐299).

Hua Lin and Ying Zhu are contributed equally to this work.

Contributor Information

Cheng Ren, Email: honghuirencheng@163.com.

Teng Ma, Email: free40@126.com.

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29. Ing C, Sun LS, Friend AF, Kim M, Berman MF, Paganelli W, et al. Differences in intraoperative hemodynamics between spinal and general anesthesia in infants undergoing pyloromyotomy. Pediatr Anaesth. 2017;27:733–741. [DOI] [PMC free article] [PubMed] [Google Scholar]
30. Hu S, Zhang Z‐Y, Hua Y‐Q, Li J, Cai Z‐D. A comparison of regional and general anaesthesia for total replacement of the hip or knee: a meta‐analysis. J Bone Jt Surg, Br Vol. 2009;91:935–942. [DOI] [PubMed] [Google Scholar]
31. White SM, Moppett I, Griffiths R, et al. Secondary analysis of outcomes after 11,085 hip fracture operations from the prospective UK Anaesthesia Sprint audit of practice (ASAP‐2). Anaesthesia. 2016;71:506–514. [DOI] [PubMed] [Google Scholar]
32. Kim BH, Lee S, Yoo B, Lee WY, Lim Y, Kim MC, et al. Risk factors associated with outcomes of hip fracture surgery in elderly patients. Korean J Anesthesiol. 2015;68:561–567. [DOI] [PMC free article] [PubMed] [Google Scholar]
33. Jakobsson J, Kalman S, Lindeberg‐Lindvet M, Bartha E. Is postspinal hypotension a sign of impaired cardiac performance in the elderly? An observational mechanistic study. Br J Anaesth. 2017;119:1178–1185. [DOI] [PubMed] [Google Scholar]
34. Ferré F, Martin C, Bosch L, Kurrek M, Lairez O, Minville V. Control of spinal anesthesia‐induced hypotension in adults. Local Reg Anesthesia. 2020;13:39–46. [DOI] [PMC free article] [PubMed] [Google Scholar]
35. Simonin M, Delsuc C, Meuret P, Caruso L, Deleat‐Besson R, Lamblin A, et al. Hypobaric unilateral spinal anesthesia versus general anesthesia for hip fracture surgery in the elderly: a randomized controlled trial. Anesth Analg. 2022;135:1262–1270. [DOI] [PubMed] [Google Scholar]
36. O'Donnell C, Black N, McCourt K, et al. Development of a Core outcome set for studies evaluating the effects of anaesthesia on perioperative morbidity and mortality following hip fracture surgery. Br J Anaesth. 2019;122:120–130. [DOI] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Figure S1. Quality assessment of the included studies.

Click here for additional data file.^{(2.9MB, tif)}

Figure S2. The forest plots of blood loss based on the included studies in a previous meta‐analysis conducted by Zheng et al.

Click here for additional data file.^{(287.4KB, tif)}

Table S1. The search steps and results of PubMed database.

Click here for additional data file.^{(35KB, doc)}

Table S2. The search steps and results of Embase database.

Click here for additional data file.^{(32KB, doc)}

Table S3. The search steps and results of the Cochrane Library database.

Click here for additional data file.^{(35KB, doc)}

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[os13895-bib-0036] 36. O'Donnell C, Black N, McCourt K, et al. Development of a Core outcome set for studies evaluating the effects of anaesthesia on perioperative morbidity and mortality following hip fracture surgery. Br J Anaesth. 2019;122:120–130. [DOI] [PubMed] [Google Scholar]

PERMALINK

Comparing the Effect of Spinal and General Anesthesia for Hip Fracture Surgery in Older Patients: A Meta‐analysis of Randomized Clinical Trials

Hua Lin, BM

Ying Zhu, BM

Cheng Ren, MD

Teng Ma, MD

Ming Li, MD

Zhong Li, MD

Yibo Xu, MD

Qian Wang, MD

Jing Hu, BM

Kun Zhang, MD

Abstract

Objective

Methods

Results

Conclusion

Introduction

Material and Methods

Search Strategy

Inclusion and Exclusion Criteria

Data Extraction

Quality Assessment

Statistical Analysis

Results

Study Selection

Fig. 1.

Characteristics of the Included Studies

TABLE 1.

Quality Assessment Results

Results of Meta‐analysis

Fig. 2.

Fig. 3.

Publication Bias

Discussion

Main Findings of this Study

The Advantages of each Type of Anesthesia

Comparison of Intraoperative Hypotension Risk and Ephedrine Dose of Two Anesthesia Techniques

Comparison of the Risk of Postoperative Complications of Two Anesthesia Techniques

Strengths and Limitations of this Study

Conclusion

Author Contributions

Conflict of Interest Statement

Supporting information

Acknowledgments

Contributor Information

References

Associated Data

Supplementary Materials

ACTIONS

PERMALINK

RESOURCES

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