{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T14:09:18Z","timestamp":1790345358415,"version":"4.1.0"},"reference-count":34,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2020,4,26]],"date-time":"2020-04-26T00:00:00Z","timestamp":1587859200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["associationofanaesthetists-publications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Anaesthesia"],"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>\n                    Around 76,000 people fracture their hip annually in the\n                    <jats:styled-content style=\"fixed-case\">UK<\/jats:styled-content>\n                    at a considerable personal, social and financial cost. Despite longstanding debate, the optimal mode of anaesthesia (general or spinal) remains unclear. Our aim was to assess whether there is a significant difference in mortality and morbidity between patients undergoing spinal anaesthesia compared with general anaesthesia during hip fracture surgery. A secondary analysis examined whether a difference exists in mortality for patients with pre\u2010existing cardiovascular disease or chronic obstructive pulmonary disease. This was a clinical database analysis of patients treated for hip fracture in Nottingham,\n                    <jats:styled-content style=\"fixed-case\">UK<\/jats:styled-content>\n                    between 2004 and 2015. Propensity score\u2010matching was used to generate matched pairs of patients, one of whom underwent each mode of anaesthesia. Data were analysed using conditional logistic regression, with 7164 patients successfully matched. There was no difference in 30\u2010 or 90\u2010day mortality in patients who had spinal rather than general anaesthesia (\n                    <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>\n                    [95%\n                    <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                    ] 0.97 [0.8\u20131.15]; p\u00a0=\u00a00.764 and 0.93 [0.82\u20131.05]; p\u00a0=\u00a00.247 respectively). Patients who had a spinal anaesthetic had a lower\u2010risk of blood transfusion (\n                    <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>\n                    [95%\n                    <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                    ] 0.84 [0.75\u20130.94]; p\u00a0=\u00a00.003) and urinary tract infection (\n                    <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>\n                    [95%\n                    <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                    ] 0.72 [0.61\u20130.84]; p\u00a0&lt;\u00a00.001), but were more likely to develop a chest infection (\n                    <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>\n                    [95%\n                    <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                    ] 1.23 [1.07\u20131.42]; p\u00a0=\u00a00.004), deep vein thrombosis (\n                    <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>\n                    [95%\n                    <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                    ] 2.18 [1.07\u20134.45]; p\u00a0=\u00a00.032) or pulmonary embolism (\n                    <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>\n                    [95%\n                    <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                    ] 2.23 [1.16\u20134.29]; p\u00a0=\u00a00.016). The mode of anaesthesia for hip fracture surgery resulted in no significant difference in mortality, but there was a significant difference in several measures of postoperative morbidity.\n                  <\/jats:p>","DOI":"10.1111\/anae.15042","type":"journal-article","created":{"date-parts":[[2020,4,27]],"date-time":"2020-04-27T02:03:12Z","timestamp":1587952992000},"page":"1173-1179","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":40,"title":["Spinal or general anaesthesia for surgical repair of hip fracture and subsequent risk of mortality and morbidity: a database analysis using propensity score\u2010matching"],"prefix":"10.1111","volume":"75","author":[{"given":"L.","family":"Morgan","sequence":"first","affiliation":[{"name":"Division of Epidemiology and Public Health University of Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T. M.","family":"McKeever","sequence":"additional","affiliation":[{"name":"Division of Epidemiology and Public Health University of Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Nightingale","sequence":"additional","affiliation":[{"name":"Department of Trauma and Orthopaedics Nottingham University Hospitals NHS Trust Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D. E.","family":"Deakin","sequence":"additional","affiliation":[{"name":"Department of Trauma and Orthopaedics Nottingham University Hospitals NHS Trust Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I. K.","family":"Moppett","sequence":"additional","affiliation":[{"name":"Anaesthesia and Critical Care Division of Clinical Neuroscience University of Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,4,26]]},"reference":[{"key":"e_1_2_6_2_1","unstructured":"PetrisorB BhandariM.BMJ best practice: hip fractures.2018.https:\/\/bestpractice.bmj.com\/topics\/en-gb\/387(accessed 27\/09\/2018)."},{"key":"e_1_2_6_3_1","unstructured":"Royal College of Physicians.National Hip Fracture Database annual report.2017.https:\/\/www.nhfd.co.uk\/files\/2017ReportFiles\/NHFD-AnnualReport2017.pdf(accessed 27\/09\/2018)."},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2010.11.010"},{"key":"e_1_2_6_5_1","first-page":"175","article-title":"Anesthesia for the elderly","volume":"11","author":"Kanonidou Z","year":"2007","journal-title":"Hippokratia"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/med\/9780199586097.001.0001"},{"key":"e_1_2_6_7_1","unstructured":"Association of Anaesthetists of Great Britain and Ireland.Anaesthetic sprint audit of practice.2014.https:\/\/www.nhfd.co.uk\/20\/hipfractureR.nsf\/vwContent\/asapReport(accessed 20\/02\/2020)."},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aep310"},{"key":"e_1_2_6_9_1","unstructured":"Royal College of Anaesthetists.Your spinal anaesthetic: information for patients.2014.https:\/\/www.rcoa.ac.uk\/sites\/default\/files\/documents\/2020-01\/03-YourSpinalweb.pdf(accessed 28\/02\/2020)."},{"key":"e_1_2_6_10_1","unstructured":"National Institute for Health and Care Excellence.Hip fracture: management.2011.https:\/\/www.nice.org.uk\/guidance\/cg124\/resources\/hip-fracture-management-pdf-35109449902789(accessed 28\/02\/2020)."},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aen236"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2018.09.008"},{"key":"e_1_2_6_13_1","first-page":"137","article-title":"Abbreviated Mental Test (cognitive) screening in acutely ill elderly surgical patients","volume":"102","author":"Sagar J","year":"2015","journal-title":"British Journal of Surgery"},{"key":"e_1_2_6_14_1","unstructured":"ThavaneswaranA LixL.Propensity score matching in observational Studies: University of Manitoba.2008.https:\/\/umanitoba.ca\/faculties\/health_sciences\/medicine\/units\/chs\/departmental_units\/mchp\/protocol\/media\/propensity_score_matching.pdf(accessed 28\/02\/2020)."},{"key":"e_1_2_6_15_1","first-page":"1465","article-title":"Anaesthesia for hip fracture surgery in adults","volume":"2","author":"Guay J","year":"2016","journal-title":"Cochrane Database of Systematic 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arthroplasty under general anaesthesia\/intravenous patient\u2010controlled analgesia compared to spinal\u2010epidural anaesthesia\/analgesia","volume":"12","author":"Chu CPW","year":"2006","journal-title":"Hong Kong Medical Journal"},{"key":"e_1_2_6_23_1","first-page":"213","article-title":"Identification of risk factors for urinary retention following total knee arthroplasty: a Singapore hospital experience","volume":"48","author":"Lingaraj K","year":"2007","journal-title":"Singapore Medical Journal"},{"key":"e_1_2_6_24_1","unstructured":"National Institute for Health and Care Excellence.Venous thromboembolism in over 16s: reducing the risk of hospital\u2010acquired deep vein thrombosis or pulmonary embolism.2018.https:\/\/www.nice.org.uk\/guidance\/ng89(accessed 28\/02\/2020)."},{"key":"e_1_2_6_25_1","first-page":"2201","article-title":"Postoperative pulmonary infections","volume":"2008","author":"Conde M","year":"2008","journal-title":"BMJ Clinical Evidence"},{"key":"e_1_2_6_26_1","unstructured":"KingG NielsenR.Why propensity scores should not be used for matching.2018.https:\/\/gking.harvard.edu\/files\/gking\/files\/pan1900011_rev.pdf(accessed 28\/02\/2020)."},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwy078"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.4065\/mcp.2009.0469"},{"key":"e_1_2_6_29_1","first-page":"987","article-title":"Effect of depth of sedation in older patients undergoing hip fracture repair on postoperative delirium: the STRIDE randomized clinical trial","volume":"153","author":"Sieber FE","year":"2018","journal-title":"Journal of the American Medical Association Surgery"},{"key":"e_1_2_6_30_1","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afy101"},{"key":"e_1_2_6_31_1","unstructured":"ISRCTN Registry.REGARD: comparing regional and general anaesthesia and their effect on delirium in patients with hip 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