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Outcomes with spinal versus general anesthesia for patients with and without preoperative cognitive impairment: Secondary analysis of a randomized clinical trial

Outcomes with spinal versus general anesthesia for patients with and without preoperative... BACKGROUNDPostoperative delirium occurs in 11%–45% of older surgical patients and is associated with postoperative mortality, cognitive decline, increased hospital length of stay, and higher health care costs.1–6 The risk of postoperative delirium is elevated in persons with preoperative cognitive impairment.7–10 Compared to general anesthesia, spinal anesthesia has been suggested to reduce the likelihood of postoperative delirium for persons with cognitive impairment.11,12 However, as prior studies comparing spinal versus general anesthesia have often excluded individuals with cognitive impairment, little is known regarding outcomes of spinal versus general anesthesia in this population.13–15The Regional versus General Anesthesia for Promoting Independence after Hip Fracture (REGAIN) trial compared outcomes with spinal versus general anesthesia among 1600 older adults undergoing hip fracture surgery at 46 US and Canadian hospitals.16 Among all participants, the incidence of new postoperative delirium did not differ by anesthesia type. The association of anesthesia type with delirium or other outcomes among participants with versus without cognitive impairment (including dementia) has not been reported.We performed a post hoc secondary analysis of REGAIN data to assess the interaction of cognitive impairment with receipt of spinal versus general anesthesia on the odds of new or worsened postoperative delirium. Secondarily, we explored differences in 60‐day http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Alzheimer s & Dementia Wiley

Outcomes with spinal versus general anesthesia for patients with and without preoperative cognitive impairment: Secondary analysis of a randomized clinical trial

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References (55)

Publisher
Wiley
Copyright
© 2023 the Alzheimer's Association.
ISSN
1552-5260
eISSN
1552-5279
DOI
10.1002/alz.13132
Publisher site
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Abstract

BACKGROUNDPostoperative delirium occurs in 11%–45% of older surgical patients and is associated with postoperative mortality, cognitive decline, increased hospital length of stay, and higher health care costs.1–6 The risk of postoperative delirium is elevated in persons with preoperative cognitive impairment.7–10 Compared to general anesthesia, spinal anesthesia has been suggested to reduce the likelihood of postoperative delirium for persons with cognitive impairment.11,12 However, as prior studies comparing spinal versus general anesthesia have often excluded individuals with cognitive impairment, little is known regarding outcomes of spinal versus general anesthesia in this population.13–15The Regional versus General Anesthesia for Promoting Independence after Hip Fracture (REGAIN) trial compared outcomes with spinal versus general anesthesia among 1600 older adults undergoing hip fracture surgery at 46 US and Canadian hospitals.16 Among all participants, the incidence of new postoperative delirium did not differ by anesthesia type. The association of anesthesia type with delirium or other outcomes among participants with versus without cognitive impairment (including dementia) has not been reported.We performed a post hoc secondary analysis of REGAIN data to assess the interaction of cognitive impairment with receipt of spinal versus general anesthesia on the odds of new or worsened postoperative delirium. Secondarily, we explored differences in 60‐day

Journal

Alzheimer s & Dementia – Wiley

Published: Sep 1, 2023

Keywords: anesthesia; delirium; dementia; hip fracture; mild cognitive impairment; surgery

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