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A multicenter retrospective study on anesthesia methods and their impact on neurocognitive outcomes and other complications in elderly patients undergoing hemiarthroplasty

Year: 2025

Type: article

Abstract: Objective: To evaluate the effects of various anesthesia techniques on perioperative neurocognitive disorders (PND) and other postoperative complications in elderly patients undergoing hemiarthroplasty for hip fractures. Methods: This multicenter retrospective observational study analyzed 5,005 elderly patients (≥65 years) with hip fractures who underwent hemiarthroplasty and had complete perioperative clinical data. Patients were categorized into five anesthesia groups: a, Combined intravenous-inhalation anesthesia (IVA + IHA); b, IVA + IHA with peripheral nerve block (PNB); c, Intravenous anesthesia (IVA) with PNB; d, Spinal anesthesia (SA); e, SA with PNB. Postoperative delirium (POD) was assessed twice daily during the first 3 postoperative days using the Confusion Assessment Method (CAM). Delayed neurocognitive recovery (DNR) was evaluated via telephone follow-up on postoperative day 7. Other postoperative complications, as well as 30-day and 6-month mortality rates, were systematically recorded. Results: > 0.05). SA & SA + PNB (de) significantly reduced POD risk: SA: OR 0.3239 (95% CI 0.2215-0.4735), 67.61% risk reduction; SA + PNB: OR 0.3634 (95% CI 0.2966-0.4452), 63.66% risk reduction (Both statistically significant, CI excludes 1). IVA + IHA: OR 1.3929 (95% CI 1.0590-1.8320) suggested potential PI risk increase, but wider CI indicates lower certainty. Conclusion: These findings suggest that regional anesthesia may be associated with lower early POD and pulmonary infection rates. Further prospective randomized controlled trials are needed to validate these results.

Source: Frontiers in Medicine

DOI: 10.3389/fmed.2025.1599989