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Comparison of risk of complication between neuraxial anaesthesia and general anaesthesia for hip fracture surgery: a systematic review and meta analysis

Int J Surg. 2023 Mar 14. doi: 10.1097/JS9.0000000000000291. Online ahead of print.


BACKGROUND: Controversy remains over the choice of anaesthetic technique for patients undergoing surgery for hip fracture.

AIM: To compare the risk of complication of neuraxial anaesthesia with general anaesthesia in patients undergoing hip fracture surgery.

METHODS: This systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and was registered at PROSPERO(CRD42022337384). The study included eligible randomised controlled trials published before February 2022. Data synthesis was performed to compare the differences between general and neuraxial anaesthesia. Meta-regression analysis was performed to investigate the influence of the publication year. Subgroup analysis was performed based on patient age and anaesthetic technique used. GRADE assessment was performed to assess the quality of each outcome.

RESULTS: Twenty randomised controlled trials and 4802 patients were included. Data synthesis revealed significant higher risk of acute kidney injury in the general anaesthesia group(P=0.01). There were no significant differences between the two techniques in postoperative short-term mortality (P=0.34), delirium (P=0.40), postoperative nausea and vomiting (P=0.40), cardiac infarction (P=0.31), acute heart failure (P=0.34) and pulmonary embolism (P=0.24) and pneumonia(P=0.15). Subgroup analysis based on patient age and use of sedative medication did not reveal any significant differences. Meta-regression analysis of the publication year versus each adverse event revealed no statistically significant differences.

CONCLUSION: A significantly higher risk of postoperative acute kidney injury was found in patients receiving general anaesthesia. This study revealed no significant differences in terms of postoperative mortality and other complications between general and neuraxial anaesthesia. The results were consistent across the age groups.

PMID:36912758 | DOI:10.1097/JS9.0000000000000291

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