{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T12:15:05Z","timestamp":1788351305633,"version":"build-2803163510"},"reference-count":13,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2023,3,14]]},"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:p>The debate over the optimal type of anesthesia for hip fracture surgery continues to rage. While retrospective evidence in elective total joint arthroplasty has suggested a reduction in complications with neuraxial anesthesia, previous retrospective studies in the hip fracture population have been mixed. Recently, two multicenter randomized, controlled trials (REGAIN and RAGA) have been published that examined delirium, ambulation at 60 days, and mortality in patients with hip fractures who were randomized to spinal or general anesthesia. These trials enrolled a combined 2,550 patients and found that spinal anesthesia did not confer a mortality benefit nor a reduction in delirium or greater proportion who could ambulate at 60 days. While these trials were not perfect, they call into question the practice of telling patients that spinal anesthesia is a \u201csafer\u201d choice for their hip fracture surgery. We believe a risk\/benefit discussion should take place with each patient and that ultimately the patient should choose his or her anesthesia type after being informed of the state of the evidence. General anesthesia is an acceptable choice for hip fracture surgery.<\/jats:p>","DOI":"10.1136\/rapm-2023-104454","type":"journal-article","created":{"date-parts":[[2023,3,28]],"date-time":"2023-03-28T10:58:55Z","timestamp":1680001135000},"page":"428-429","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["General anesthesia is an acceptable choice for hip fracture surgery"],"prefix":"10.1136","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3464-4149","authenticated-orcid":false,"given":"Eric S","family":"Schwenk","sequence":"first","affiliation":[{"name":"Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colin JL","family":"McCartney","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Pain Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,3,28]]},"reference":[{"key":"2025101109360257000_48.8.428.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2113514"},{"key":"2025101109360257000_48.8.428.2","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":"2025101109360257000_48.8.428.3","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e3182545e7c"},{"key":"2025101109360257000_48.8.428.4","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2014.6499"},{"key":"2025101109360257000_48.8.428.5","doi-asserted-by":"publisher","DOI":"10.1001\/jama.294.2.218"},{"key":"2025101109360257000_48.8.428.6","article-title":"Intravenous versus inhalational maintenance of anaesthesia for postoperative cognitive outcomes in elderly people undergoing non-cardiac surgery","volume":"8","author":"Miller","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"key":"2025101109360257000_48.8.428.7","doi-asserted-by":"crossref","first-page":"704","DOI":"10.1016\/j.bja.2021.07.021","article-title":"Anaesthetic depth and delirium after major surgery: a randomised clinical trial","volume":"127","author":"Evered","year":"2021","journal-title":"Br J Anaesth"},{"key":"2025101109360257000_48.8.428.8","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1111\/aas.12495","article-title":"Total intravenous general anaesthesia vs. spinal anaesthesia for total hip arthroplasty","volume":"59","author":"Harsten","year":"2015","journal-title":"Acta Anaesthesiol Scand"},{"key":"2025101109360257000_48.8.428.9","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aet104"},{"key":"2025101109360257000_48.8.428.10","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aep096"},{"key":"2025101109360257000_48.8.428.11","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1097\/AAP.0b013e318217a68e","article-title":"Spinal anesthesia failure after local anesthetic injection into cerebrospinal fluid: a multicenter prospective analysis of its incidence and related risk factors in 1214 patients","volume":"36","author":"Fuzier","year":"2011","journal-title":"Reg Anesth Pain Med"},{"key":"2025101109360257000_48.8.428.12","doi-asserted-by":"crossref","first-page":"952","DOI":"10.7326\/M22-0320","article-title":"Pain, analgesic use, and patient satisfaction with spinal versus general anesthesia for hip fracture surgery: a randomized clinical trial","volume":"175","author":"Neuman","year":"2022","journal-title":"Ann Intern Med"},{"key":"2025101109360257000_48.8.428.13","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1016\/j.bja.2019.05.042","article-title":"Anaesthetic care of patients undergoing primary hip and knee arthroplasty: consensus recommendations from the international consensus on anaesthesia-related outcomes after surgery group (icaros) based on a systematic review and meta-analysis","volume":"123","author":"Memtsoudis","year":"2019","journal-title":"Br J Anaesth"}],"container-title":["Regional Anesthesia &amp; Pain Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/rapm-2023-104454","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T16:36:09Z","timestamp":1760200569000},"score":1,"resource":{"primary":{"URL":"https:\/\/rapm.bmj.com\/lookup\/doi\/10.1136\/rapm-2023-104454"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,28]]},"references-count":13,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2023,6,23]]},"published-print":{"date-parts":[[2023,8]]}},"alternative-id":["10.1136\/rapm-2023-104454"],"URL":"https:\/\/doi.org\/10.1136\/rapm-2023-104454","relation":{},"ISSN":["1098-7339","1532-8651"],"issn-type":[{"value":"1098-7339","type":"print"},{"value":"1532-8651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,28]]}}}