J Int Med Res. 2026 Jun;54(6):3000605261463455. doi: 10.1177/03000605261463455. Epub 2026 Jun 27.
ABSTRACT
ObjectiveHip and femur fractures in older adults are linked to high morbidity, mortality, and socioeconomic costs. This meta-analysis compares regional anesthesia and general anesthesia for these surgeries, focusing on perioperative safety and outcomes.MethodsFifteen studies (6829 participants) from 2009 to 2024 were analyzed. Primary outcomes included 30-day mortality, postoperative delirium, and cardiovascular events; secondary outcomes covered intraoperative blood loss, hospital stay, and pain. Pooled effect sizes were calculated using random-effects models with odds ratios and 95% confidence intervals. Heterogeneity was assessed using the I2 statistic. Risk of bias was evaluated with Risk of Bias 2.0 (randomized controlled trials) and Risk Of Bias In Nonrandomized Studies of Interventions (observational studies). Certainty of evidence was rated using the Grading of Recommendations Assessment, Development and Evaluation approach.ResultsPooled analysis showed no significant difference in 30-day mortality between regional anesthesia and general anesthesia (odds ratio = 0.89 (0.72-1.10), p = 0.28, I2 = 34%). Regional anesthesia was associated with significantly lower hypotension rates (odds ratio = 0.28 (0.18-0.43), p < 0.001, I2 = 52%). There was a nonsignificant trend toward lower postoperative delirium with regional anesthesia (odds ratio = 0.78 (0.60-1.01), p = 0.06, I2 = 46%). Pain management favored general anesthesia in one large trial (severe pain: 28.8% vs. 42.3%, p < 0.01), but other studies showed no difference. No significant differences were found in long-term mortality or functional recovery (p > 0.05 for all). Substantial heterogeneity (I2 > 50%) was noted for some outcomes because of variations in age, fracture type, and study design.ConclusionRegional anesthesia may offer perioperative benefits, including reduced hypotension and a possible (but not statistically confirmed) reduction in postoperative delirium. General anesthesia provides better early pain control in some patients and remains suitable for complex cases. Individualized anesthesia plans are recommended. Future research should prioritize standardized outcomes and larger trials.
PMID:42363795 | DOI:10.1177/03000605261463455
