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O’Brien K, Feng R, Sieber F, Marcantonio ER, Tierney A, Magaziner J, Carson JL, Dillane D, Sessler DI, Menio D, Ayad S, Stone T, Papp S, Schwenk ES, Marshall M, Jaffe JD, Luke C, Sharma B, Azim S, Hymes R, Chin KJ, Sheppard R, Perlman B, Sappenfield J, Hauck E, Hoeft MA, Karlawish J, Mehta S, Donegan DJ, Horan A, Ellenberg SS, Neuman MD, Investigators R: Outcomes with spinal versus general anesthesia for patients with and without preoperative cognitive impairment: Secondary analysis of a randomized clinical trial. Alzheimers Dement 2023; 19: 4008-4019

February 25, 2023

INTRODUCTION:
The effect of spinal versus general anesthesia on the risk of postop- erative delirium or other outcomes for patients with or without cognitive impairment (including dementia) is unknown.
METHODS:
Post hoc secondary analysis of a multicenter pragmatic trial comparing spinal versus general anesthesia for adults aged 50 years or older undergoing hip fracture surgery.
RESULTS:
Among patients randomized to spinal versus general anesthesia, new or worsened delirium occurred in 100/295 (33.9%) versus 107/283 (37.8%; odds ratio [OR] 0.85; 95% confidence interval [CI] 0.60 to 1.19) among persons with cognitive impairment and 70/432 (16.2%) versus 71/445 (16.0%) among persons without cog- nitive impairment (OR 1.02; 95% CI 0.71 to 1.47, p = 0.46 for interaction). Delirium severity, in-hospital complications, and 60-day functional recovery did not differ by anesthesia type in patients with or without cognitive impairment.
DISCUSSION:
Anesthesia type is not associated with differences in delirium and functional outcomes among persons with or without cognitive impairment.
KEYWORDS:
anesthesia, delirium, dementia, hip fracture, mild cognitive impairment, surgery.