Hip Fracture Surgery Delirium Risk After Regional and General Anesthesia Evaluated in New Study

Older patients undergoing surgery often experience a complication known as post-surgical delirium, which is often attributed to the effects of general anesthesia. However, the findings of a new study suggest that after hip fracture surgery, the delirium risk is no less among older individuals who receive regional anesthesia.

In a report published late last month in the Journal of the American Medical Association (JAMA), Chinese researchers sought to determine whether regional anesthesia may be an alternative to general anesthesia, which would help prevent delirium among. However, the study determined that the chances of post-surgical delirium were the same, regardless of which type of anesthesia was used.

The study involved a randomized clinical trial including 950 older adults undergoing surgical repair for hip fracture conducted at nine university teaching hospitals in Southeastern China from 2014 to 2018. Patients were randomly chosen to receive either regional anesthesia or general anesthesia.

Regional anesthesia includes spinal, epidural or both types of anesthesia combined with no sedation. General anesthesia includes intravenous, inhalation, or combined sedation agents.

The incidence of delirium among patients who underwent regional anesthesia without sedation was 6% and the incidence of delirium among patients who underwent general anesthesia was 5%. The data indicated there was no statistically significance difference between the two groups.

Patients were assigned a delirium severity score after surgery. The average severity score for the regional anesthesia group was 23 and the average score for the general group was 24. Both groups experienced delirium in roughly the same severity.

“In patients aged 65 years and older undergoing hip fracture surgery, regional anesthesia without sedation did not significantly reduce the incidence of postoperative delirium compared with general anesthesia,” the researchers concluded.

Post-operative delirium is a common complication after surgery, especially among older patients. It is a serious, neurological complication marked by change in brain function after surgery and can lead to increased risk of death, dementia, post-traumatic stress disorder, longer hospital stays and extra nursing attention.

Research published last year in the journal JAMA Surgery indicated post-operative delirium costs can exceed $50,000 per patient. Costs per patient reached up to $146,000 in some cases, including the costs for prolonged hospital stays, infection treatment, electrolyte imbalance and other side effects. The side effects can result in significant costs to both the patient and the healthcare system overall.

Researchers have long believed post-surgical delirium among older patients to be caused by general anesthesia and believed administering regional anesthesia would reduce the incidence of occurrence. The findings of this study indicate that is not the case and older patients can suffer post-surgical delirium whether they undergo general or regional anesthesia, and other factors must play a role in the condition.