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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.
O'Brien, Kyra; Feng, Rui; Sieber, Frederick; Marcantonio, Edward R; Tierney, Ann; Magaziner, Jay; Carson, Jeffrey L; Dillane, Derek; Sessler, Daniel I; Menio, Diane; Ayad, Sabry; Stone, Trevor; Papp, Steven; Schwenk, Eric S; Marshall, Mitchell; Jaffe, J Douglas; Luke, Charles; Sharma, Balram; Azim, Syed; Hymes, Robert; Chin, Ki-Jinn; Sheppard, Richard; Perlman, Barry; Sappenfield, Joshua; Hauck, Ellen; Hoeft, Mark A; Karlawish, Jason; Mehta, Samir; Donegan, Derek J; Horan, Annamarie; Ellenberg, Susan S; Neuman, Mark D.
Affiliation
  • O'Brien K; Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
  • Feng R; Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
  • Sieber F; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
  • Marcantonio ER; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
  • Tierney A; Department of Medicine, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts, USA.
  • Magaziner J; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
  • Carson JL; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.
  • Dillane D; Division of General Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
  • Sessler DI; Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Canada.
  • Menio D; Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA.
  • Ayad S; Center for Advocacy for the Rights and Interests of the Elderly, Philadelphia, Pennsylvania, USA.
  • Stone T; Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA.
  • Papp S; Department of Orthopaedics, University of British Columbia, Vancouver, Canada.
  • Schwenk ES; Division of Orthopaedics, Ottawa Hospital Civic Campus, Ottawa, Canada.
  • Marshall M; Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
  • Jaffe JD; Department of Anesthesiology, New York University Langone Medical Center, New York, New York, USA.
  • Luke C; Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
  • Sharma B; Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
  • Azim S; Department of Anesthesiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA.
  • Hymes R; Department of Anesthesiology, Stony Brook University, Stony Brook, New York, USA.
  • Chin KJ; Department of Orthopedic Surgery, Inova Fairfax Medical Campus, Falls Church, Virginia, USA.
  • Sheppard R; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada.
  • Perlman B; Department of Anesthesiology, Hartford Hospital, Hartford, Connecticut, USA.
  • Sappenfield J; Department of Internal Medicine, Peacehealth Medical Group, Springfield, Oregon, USA.
  • Hauck E; Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA.
  • Hoeft MA; Department of Anesthesiology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA.
  • Karlawish J; Department of Anesthesiology, University of Vermont Larner College of Medicine, Burlington, Vermont, USA.
  • Mehta S; Department of Internal Medicine, Division of Geriatric Medicine, Perelman School of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
  • Donegan DJ; Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
  • Horan A; Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
  • Ellenberg SS; Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
  • Neuman MD; Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
Alzheimers Dement ; 19(9): 4008-4019, 2023 09.
Article in En | MEDLINE | ID: mdl-37170754
ABSTRACT

INTRODUCTION:

The effect of spinal versus general anesthesia on the risk of postoperative delirium or other outcomes for patients with or without cognitive impairment (including dementia) is unknown.

METHODS:

Post hoc secondary analysis of a multicenter pragmatic trial comparing spinal versus general anesthesia for adults aged 50 years or older undergoing hip fracture surgery.

RESULTS:

Among patients randomized to spinal versus general anesthesia, new or worsened delirium occurred in 100/295 (33.9%) versus 107/283 (37.8%; odds ratio [OR] 0.85; 95% confidence interval [CI] 0.60 to 1.19) among persons with cognitive impairment and 70/432 (16.2%) versus 71/445 (16.0%) among persons without cognitive impairment (OR 1.02; 95% CI 0.71 to 1.47, p = 0.46 for interaction). Delirium severity, in-hospital complications, and 60-day functional recovery did not differ by anesthesia type in patients with or without cognitive impairment.

DISCUSSION:

Anesthesia type is not associated with differences in delirium and functional outcomes among persons with or without cognitive impairment.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Delirium / Cognitive Dysfunction / Hip Fractures Type of study: Clinical_trials / Etiology_studies Limits: Humans Language: En Journal: Alzheimers Dement Year: 2023 Type: Article Affiliation country: United States
Fulltext
Print
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PubMed Links
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Delirium / Cognitive Dysfunction / Hip Fractures Type of study: Clinical_trials / Etiology_studies Limits: Humans Language: En Journal: Alzheimers Dement Year: 2023 Type: Article Affiliation country: United States