Sarasota, FL (WorkersCompensation.com) – Outcomes and cost are usually at the forefront of considerations when considering surgical intervention for patients. The anesthesia type is a vital part of the decision making process, with general or spinal anesthesia as the two main options. In addition to possible issues with placement in spinal anesthesia, some studies have potentially shown that the cost for general anesthesia is around 9 percent higher than spinal anesthesia, however new evidence suggests that the outcomes are about the same.
While observational studies have suggested that spinal anesthesia has a lower mortality rate and complications, as well as shorter lengths of stay, there are few recent randomized trials that take into account newer methods used in general anesthesia, or outcomes past hospital stay.
Researchers conducted a randomized trial in hip surgery patients to determine if the anesthesia method used impacted outcomes and mobility. The trial took place at 46 hospitals across the United States and Canada. A total of 1,600 patients were initially included, aged 50 years or older, with the average age of 78. The majority of the patients were female, comprising 67 percent of the patients.
Primary outcomes were determined by death or an inability to walk 10 feet unassisted or with a walker or cane at 60 days post randomization. Secondary outcomes were assessed at a 60 day benchmark for death, disorientation, time to discharge, and mobility. Exploratory outcomes included complications during hospital stay, time to first ambulation, and discharge location.
Initially, 795 patients were assigned to receive spinal anesthesia, and 805 were assigned to receive general anesthesia. Of the spinal group, 119 were re-assigned for general anesthesia due to issues with block placement, changes in the clinician selection, and general patient preferences. Of the general anesthesia group, only 28 were re-assigned for spinal anesthesia.
Researchers were able to review the sedation data on 502 patients. Eighty-five percent had an Observer’s Assessment of Alertness/Sedation (OAA/S) score between 5 (lighter) and 2(deeper), and 14.1 percent required deeper sedation. The median total anesthesia time was 132 minutes for the spinal group, compared to 131 minutes for the general surgery group.
Death or a new inability to walk the required distance occurred in 18.5 percent of the spinal group, and 18 percent of the general anesthesia group. New onset delirium occurred in 20.5 percent of the spinal patients, and 19.7 percent of the general anesthesia group. The death rate during hospitalization in the spinal group was .6 percent, and in the general anesthesia group was 1.6 percent. Acute kidney issues occurred in 4.5 percent of the spinal group, and 2.3 percent were admitted to critical care. Of the general anesthesia group, the rate was higher at 7.6 percent for kidney issues, and 3.7 percent admitted to critical care.
Overall, the researchers concluded that for hip-fracture surgery in older adults, spinal anesthesia is not superior to general anesthesia in regards to survival and recovery of mobility.
The full results of the clinical trial are available on The New England Journal Of Medicine.
