Neuraxial anesthesia compared to general anesthesia in subjects with hip fracture surgery: A meta-analysis

Background We performed a meta-analysis to evaluate the effects of neuraxial anesthesia compared to general anesthesia on postoperative results in hip fracture surgery subjects. Methods A systematic literature search up to January 2021 was done and 20 studies included 298785 subjects with hip fracture surgery at the start of the study; 80783 of them were under neuraxial anesthesia, and 218002 of them were under general anesthesia. They were reporting relationships between the effects of neuraxial anesthesia compared to general anesthesia in subjects with hip fracture surgery. We calculated the odds ratio (OR) or the mean difference (MD) with 95% confidence intervals (CIs) to assess the effects of neuraxial anesthesia compared to general anesthesia in subjects with hip fracture surgery using the dichotomous or continuous method with a random or fixed-effect model. Results Neuraxial anesthesia in subjects with hip fracture surgery was significantly related to lower acute myocardial infarction (OR, 0.73; 95% CI, 0.54-0.99, p=0.04), hypotension (OR, 0.37; 95% CI, 0.20-0.70, p=0.002), and postoperative cognitive dysfunction postoperative 1day (OR, 0.27; 95% CI, 0.17-0.42, p<0.001) compared to general anesthesia. However, no significant difference was found between neuraxial anesthesia and general anesthesia in subjects with hip fracture surgery in a postoperative cognitive dysfunction postoperative 7days (OR, 0.64; 95% CI, 0.37-1.09, p=0.10), pneumonia (OR, 0.69; 95% CI, 0.29-1.62, p=0.39), length of hospital stay (MD, 0.75; 95% CI, -1.39-2.90, p=0.49),  deep venous thrombosis (OR, 1.21; 95% CI, 0.50-2.95, p=0.68), 30-day mortality (OR, 1.12; 95% CI, 0.53-2.34, p=0.77), blood loss (MD, -57.47; 95% CI, -123.36-8.41, p=0.09), and delirium (OR, 0.98; 95% CI, 0.32-2.49, p=0.96). Conclusions Neuraxial anesthesia in subjects with hip fracture surgery may decrease the risk of acute myocardial infarction, hypotension, and postoperative cognitive dysfunction postoperative 1 day compared to general anesthesia. Furthers studies are required to validate these findings.