A new study from the University of Bristol has found no differences in the safety or effectiveness of spinal or general anaesthesia for hip fracture surgery.
In collaboration with the University of Warwick, Bristol researchers analysed previously published data on nearly 4,000 hip fracture patients. They looked for differences in safety and effectiveness of two common types of anaesthetic – spinal versus general anaesthesia – for patients undergoing hip fracture surgery.
The research was funded by The Academy of Medical Sciences and supported by the NIHR Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust and the University of Bristol.
Hip fracture surgery: A healthcare challenge
Hip fractures are one of the largest healthcare burdens faced by medical professionals. The number of hip fractures increases with age, and medical data illustrates that hip fractures are expected to rise to 6.26 million per year in 2050.
Figures from 2017 have shown that hip fracture surgery and other treatments cost the NHS over £1 billion, with further projections indicating that this figure will increase to £5.6bn in 2033.
Most patients will have hip fracture surgery, requiring anaesthesia, so the surgery is safe and not painful. The majority of patients receive either spinal or general anaesthesia. As most hip fracture patients are older, more fragile and may possess comorbidities, surgery is also associated with a high risk of developing post-operative complications including delirium, pneumonia, stroke and death.
Whilst previous studies have tried to determine how the type of anaesthesia may influence the outcome; however, the results have remained inconclusive. Now, the researchers set out to find a solid answer to this. They conducted a meta-analysis on the results of 15 hip fracture Randomised Control Trials (RCTs) using modern anaesthetic techniques (spinal or general anaesthetic) published between 2003 and 2022, involving 3,866 participants aged 66-86 years who experienced hip fracture surgery.
No clinical differences between spinal and general anaesthetic
The researchers discovered that except for acute kidney injury, there was no difference between spinal and general anaesthesia in hip fracture surgery patients in terms of mortality, acute coronary syndrome, hypotension, acute kidney injury, delirium, pneumonia, orthogeriatric input, being out of bed at day-one post-operatively, pain, and in important patient defined outcomes (return to pre-operative residence, quality of life, and mobility status).
Mr Gulraj Matharu, the study’s senior author and a Clinical Lecturer at the University of Bristol’s Bristol Medical School, said: “Our findings suggest there is no difference in outcomes for patients when having either spinal or general anaesthesia for hip fracture surgery. The clinical decision to use a particular anaesthetic is a complex process and should be based on the patient’s risk profile and preference, as well as the expertise of the anaesthetist. Our findings are therefore reassuring for clinicians who can continue to use either type of anaesthetic at this time.
“However, the evidence we assessed ranged from high to very low-quality studies. Furthermore, most studies only reported one to three outcomes from the recently devised core outcome set and only a few studies reported on any outcomes that were considered important to patients. This is something that can be improved on when designing future research studies in this area. Therefore, we feel that outcomes which are specifically important to patients (including pre-operative residence, quality of life, and mobility status) should be incorporated into future trials comparing anaesthetic techniques in patients undergoing hip fracture surgery.”
