{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T23:49:07Z","timestamp":1793144947384,"version":"4.5.0"},"reference-count":26,"publisher":"BMJ","issue":"1","funder":[{"DOI":"10.13039\/100005831","name":"Foundation for Anesthesia Education and Research","doi-asserted-by":"publisher","award":["MRTG-08-15-2021-White (Robert)"],"award-info":[{"award-number":["MRTG-08-15-2021-White (Robert)"]}],"id":[{"id":"10.13039\/100005831","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"crossref","award":["5R03AG074070-02"],"award-info":[{"award-number":["5R03AG074070-02"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2023,4,5]]},"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>There is a lack of consensus in the literature as to whether anesthetic modality influences perioperative complications in hip fracture surgery. The aim of the present study was to assess the effect of spinal anesthesia compared with general anesthesia on postoperative morbidity and mortality in patients who underwent hip fracture surgery using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We used the ACS NSQIP to identify patients aged 50 and older who received either spinal or general anesthesia for hip fracture surgery from 2016 to 2019. Propensity-score matching was performed to control for clinically relevant covariates. The primary outcome of interest was the combined incidence of stroke, myocardial infarction (MI) or death within 30 days. Secondary outcomes included 30-day mortality, hospital length of stay and operative time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among the 40\u2009527 patients aged 50 and over who received either spinal or general anesthesia for hip fracture surgery from 2016 to 2019, 7358 spinal anesthesia cases were matched to general anesthesia cases. General anesthesia was associated with a higher incidence of combined 30-day stroke, MI or death compared with spinal anesthesia (OR 1.219 (95% CI 1.076 to 1.381); p=0.002). General anesthesia was also associated with a higher frequency of 30-day mortality (OR 1.276 (95% CI 1.099 to 1.481); p=0.001) and longer operative time (64.73 vs 60.28\u2009min; p&lt;0.001). Spinal anesthesia had a longer average hospital length of stay (6.29 vs 5.73\u2009days; p=0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our propensity-matched analysis suggests that spinal anesthesia as compared with general anesthesia is associated with lower postoperative morbidity and mortality in patients undergoing hip fracture surgery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rapm-2022-104217","type":"journal-article","created":{"date-parts":[[2023,5,2]],"date-time":"2023-05-02T11:31:14Z","timestamp":1683027074000},"page":"4-9","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":35,"title":["Improved outcomes for spinal versus general anesthesia for hip fracture surgery: a retrospective cohort study of the National Surgical Quality Improvement Program"],"prefix":"10.1136","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1438-1575","authenticated-orcid":false,"given":"Eliana R","family":"Weinstein","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, NewYork-Presbyterian Weill Cornell Medical Center, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard B","family":"Boyer","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, NewYork-Presbyterian Weill Cornell Medical Center, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert S","family":"White","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, NewYork-Presbyterian Weill Cornell Medical Center, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roniel Y","family":"Weinberg","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, NewYork-Presbyterian Weill Cornell Medical Center, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob M","family":"Lurie","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, NewYork-Presbyterian Weill Cornell Medical Center, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Salvatierra","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, NewYork-Presbyterian Weill Cornell Medical Center, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9631-6389","authenticated-orcid":false,"given":"Tiffany R","family":"Tedore","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, NewYork-Presbyterian Weill Cornell Medical Center, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,5,2]]},"reference":[{"key":"2025101112125296000_49.1.4.1","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1007\/s00198-017-4345-0","article-title":"Hip fracture trends in the United States, 2002 to 2015","volume":"29","author":"Michael Lewiecki","year":"2018","journal-title":"Osteoporos Int"},{"key":"2025101112125296000_49.1.4.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2018.04.015"},{"key":"2025101112125296000_49.1.4.3","doi-asserted-by":"crossref","first-page":"493","DOI":"10.5152\/j.aott.2021.21004","article-title":"Analysis of risk factors affecting mortality in elderly patients operated on for hip fractures: a retrospective comparative study","volume":"55","author":"Bi\u00e7en","year":"2021","journal-title":"Acta Orthop Traumatol Turc"},{"issue":"Pt A","key":"2025101112125296000_49.1.4.4","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.ijsu.2015.11.009","article-title":"Hip fractures in patients older than 75 years old: retrospective analysis for prognostic factors","volume":"24","author":"Karademir","year":"2015","journal-title":"Int J Surg"},{"key":"2025101112125296000_49.1.4.5","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1097\/BOT.0000000000002273","article-title":"Effects of spinal anesthesia in geriatric hip fracture: a propensity-matched study","volume":"36","author":"Rodkey","year":"2022","journal-title":"J Orthop 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Surgery"},{"key":"2025101112125296000_49.1.4.11","doi-asserted-by":"crossref","first-page":"3429","DOI":"10.1016\/j.arth.2017.05.038","article-title":"No clinical difference comparing general, regional, and combination anesthesia in hip arthroplasty: a multicenter cohort-study regarding perioperative pain management and patient satisfaction","volume":"32","author":"Greimel","year":"2017","journal-title":"The Journal of Arthroplasty"},{"key":"2025101112125296000_49.1.4.12","doi-asserted-by":"crossref","first-page":"1321","DOI":"10.1007\/s00264-015-2735-5","article-title":"Regional anaesthesia for hip fracture surgery is associated with significantly more peri-operative complications compared with general anaesthesia","volume":"39","author":"Whiting","year":"2015","journal-title":"International Orthopaedics (SICOT)"},{"key":"2025101112125296000_49.1.4.13","unstructured":"American College of Surgeons . User guide for the 2019 ACS NSQIP procedure targeted participant use data file (PUF). Available: https:\/\/www.facs.org\/media\/4m1eod3p\/pt_nsqip_puf_userguide_2019.pdf [Accessed 21 Dec 2022]."},{"key":"2025101112125296000_49.1.4.14","unstructured":"User guide for the 2019 ACS NSQIP participant use data file (PUF). American College of Surgeons National Surgical Quality Improvement Program. Available: https:\/\/www.facs.org\/media\/isko30q1\/nsqip_puf_userguide_2019.pdf [Accessed 9 Dec 2022]."},{"key":"2025101112125296000_49.1.4.15","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.jclinane.2019.05.010","article-title":"Clinical predictors of postoperative delirium, functional status, and mortality in geriatric patients undergoing non-elective surgery for hip fracture","volume":"58","author":"Harris","year":"2019","journal-title":"J Clin Anesth"},{"key":"2025101112125296000_49.1.4.16","doi-asserted-by":"crossref","first-page":"1066","DOI":"10.1213\/ANE.0000000000002787","article-title":"Five steps to successfully implement and evaluate propensity score matching in clinical research studies","volume":"127","author":"Staffa","year":"2018","journal-title":"Anesthesia & Analgesia"},{"key":"2025101112125296000_49.1.4.17","doi-asserted-by":"crossref","DOI":"10.1186\/s12871-017-0380-9","article-title":"General vs. neuraxial anaesthesia in hip fracture patients: a systematic review and meta-analysis","volume":"17","author":"Van Waesberghe","year":"2017","journal-title":"BMC Anesthesiol"},{"key":"2025101112125296000_49.1.4.18","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1007\/s40520-021-01896-x","article-title":"Comorbidity and the association with 1-year mortality in hip fracture patients: can the ASA score and the Charlson comorbidity index be used interchangeably?","volume":"34","author":"Ek","year":"2022","journal-title":"Aging Clin Exp Res"},{"key":"2025101112125296000_49.1.4.19","doi-asserted-by":"crossref","first-page":"2379","DOI":"10.1016\/j.injury.2021.02.004","article-title":"30-Day mortality in patients after hip fracture surgery: a comparison of the Charlson comorbidity index score and ASA score used in two prediction models","volume":"52","author":"Haugan","year":"2021","journal-title":"Injury"},{"key":"2025101112125296000_49.1.4.20","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1302\/0301-620X.100B2.BJJ-2017-0791.R1","article-title":"Missing data may lead to changes in hip fracture database studies: a study of the American College of surgeons national surgical quality improvement program","volume":"100-B","author":"Basques","year":"2018","journal-title":"Bone Joint J"},{"key":"2025101112125296000_49.1.4.21","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1001\/jama.2021.22647","article-title":"Effect of regional vs general anesthesia on incidence of postoperative delirium in older patients undergoing hip fracture surgery: the RagA randomized trial","volume":"327","author":"Li","year":"2022","journal-title":"JAMA"},{"key":"2025101112125296000_49.1.4.22","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e3182545e7c"},{"key":"2025101112125296000_49.1.4.23","unstructured":"Physicians . 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Regard: comparing regional and general anaesthesia and their effect on delirium in patients with hip fractures. doi:10.1186\/ISRCTN15165914","DOI":"10.1186\/ISRCTN15165914"},{"key":"2025101112125296000_49.1.4.26","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2018-023609","article-title":"Improve hip fracture outcome in the elderly patient (ihope): a study protocol for a pragmatic, multicentre randomised controlled trial to test the efficacy of spinal versus general anaesthesia","volume":"8","author":"Kowark","year":"2018","journal-title":"BMJ Open"}],"container-title":["Regional Anesthesia &amp; Pain Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/rapm-2022-104217","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T19:13:00Z","timestamp":1760209980000},"score":1,"resource":{"primary":{"URL":"https:\/\/rapm.bmj.com\/lookup\/doi\/10.1136\/rapm-2022-104217"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,2]]},"references-count":26,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,1,11]]},"published-print":{"date-parts":[[2024,1]]}},"alternative-id":["10.1136\/rapm-2022-104217"],"URL":"https:\/\/doi.org\/10.1136\/rapm-2022-104217","relation":{},"ISSN":["1098-7339","1532-8651"],"issn-type":[{"value":"1098-7339","type":"print"},{"value":"1532-8651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,2]]}}}