{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T12:24:11Z","timestamp":1777379051981,"version":"3.51.4"},"reference-count":20,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2025,1,6]],"date-time":"2025-01-06T00:00:00Z","timestamp":1736121600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Anaesth Intensive Care"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:p>\n                    Delirium is the most common in-hospital complication affecting older adults with acute hip fractures. Current evidence demonstrates inconsistent associations between anaesthetic type for acute hip fracture surgery and postoperative delirium. Using the Australian and New Zealand Hip Fracture Registry database, we conducted a retrospective cohort study of patients aged 50 years and over who underwent acute hip fracture surgery between 2015 and 2020. The incidence of delirium in patients who received general anaesthesia alone or combined with a regional technique, versus those who received spinal or regional anaesthesia was assessed. Multivariable multilevel logistic regression was used to test associations between anaesthetic type and delirium controlling for known confounders. Finally, given hospital variation in preference for anaesthetic type, an instrumental variable analysis was performed to include the effect of both known and unknown confounding. Of 35,252 patients, 25,682 (72.9%) patients received general anaesthesia, and 9570 (27.2%) patients received spinal or regional anaesthesia for their hip fracture surgery. A higher proportion of patients who received general anaesthesia developed delirium than those who received spinal or regional anaesthesia (40.6% vs. 35.7%, odds ratio (OR) 1.23, 95% confidence intervals (CI) 1.18 to 1.30,\n                    <jats:italic>P<\/jats:italic>\n                    \u2009&lt;\u20090.0001). After adjusting for known confounders, general anaesthesia patients were at slightly increased odds of developing delirium (OR 1.14, 95% CI 1.04 to 1.25,\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.0052). However, the instrumental variable analysis found no statistically significant difference between groups (OR 1.03, 95% CI 0.99 to 1.07,\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.141). Therefore, while a weak association was found between general anaesthesia exposure and postoperative delirium, an instrumental variable analysis to compensate for unmeasured confounding showed no causal association between general anaesthesia and postoperative delirium.\n                  <\/jats:p>","DOI":"10.1177\/0310057x241275116","type":"journal-article","created":{"date-parts":[[2025,1,6]],"date-time":"2025-01-06T03:37:58Z","timestamp":1736134678000},"page":"116-124","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["The effect of type of anaesthetic on delirium after surgery for acute hip fracture: An instrumental variable analysis to assess causation"],"prefix":"10.1177","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7251-3441","authenticated-orcid":false,"given":"Anna-Marie G","family":"Tanios","sequence":"first","affiliation":[{"name":"Mater Health Services, Brisbane, Australia"},{"name":"Neuroscience Research Australia (NeuRA), Sydney, Australia"},{"name":"School of Medicine, University of Queensland, Brisbane, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily L","family":"Gallagher","sequence":"additional","affiliation":[{"name":"Mater Health Services, Brisbane, Australia"},{"name":"Neuroscience Research Australia (NeuRA), Sydney, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael S","family":"McManus","sequence":"additional","affiliation":[{"name":"Mater Health Services, Brisbane, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John A","family":"Riordan","sequence":"additional","affiliation":[{"name":"Mater Health Services, Brisbane, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0887-7627","authenticated-orcid":false,"given":"Ian A","family":"Harris","sequence":"additional","affiliation":[{"name":"Neuroscience Research Australia (NeuRA), Sydney, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lara A","family":"Harvey","sequence":"additional","affiliation":[{"name":"Neuroscience Research Australia (NeuRA), Sydney, Australia"},{"name":"School of Population Health, University of New South Wales, Sydney, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,1,6]]},"reference":[{"key":"e_1_3_5_2_2","unstructured":"Australian and New Zealand Hip Fracture Registry. Australian and New Zealand Hip Fracture Registry Annual Report of Hip Fracture Care; August 2020 Sydney. https:\/\/anzhfr.org\/wp-content\/uploads\/sites\/1164\/2022\/01\/ANZHFR-2020-Annual-Report-FULL.pdf. (accessed December 2023)."},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.5694\/mja2.51440"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.15870"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12877-016-0291-5"},{"key":"e_1_3_5_6_2","first-page":"1","article-title":"The DSM-5 criteria, level of arousal and delirium diagnosis: inclusiveness is safer","volume":"12","author":"Boustani M","year":"2014","unstructured":"Boustani M, Rudolph J, Shaughnessy M, et\u00a0al. The DSM-5 criteria, level of arousal and delirium diagnosis: inclusiveness is safer. BMC Med 2014; 12: 1\u20132. doi:10.1186\/s12916-014-0141-2","journal-title":"BMC Med"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1002\/gps.4655"},{"key":"e_1_3_5_8_2","first-page":"1","article-title":"Non-pharmacological interventions for preventing delirium in hospitalised non-ICU patients","volume":"2021","author":"Burton JK","year":"2021","unstructured":"Burton JK, Craig L, Yong SQ, et\u00a0al. Non-pharmacological interventions for preventing delirium in hospitalised non-ICU patients. Cochrane Database Syst Rev 2021; 2021: 1\u20132,8. doi:10.1002\/14651858.CD013307","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.1002\/gps.5408"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.22647"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2022.06.022"},{"key":"e_1_3_5_12_2","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/29.4.722"},{"key":"e_1_3_5_13_2","unstructured":"Australian and New Zealand Hip Fracture Registry. Australian and New Zealand Hip Fracture Registry Data Dictionary: Version 14. October 2021 Sydney. https:\/\/anzhfr.org\/wp-content\/uploads\/sites\/1164\/2022\/01\/ANZHFR_DataDictionary_v14_October-2021_FINAL.pdf (accessed December 2023)."},{"key":"e_1_3_5_14_2","volume-title":"Causal Inference: What If","author":"Hern\u00e1n M","year":"2020","unstructured":"Hern\u00e1n M, Robins J. Causal Inference: What If. Boca Raton: Chapman & Hall\/CRC, 2020."},{"key":"e_1_3_5_15_2","doi-asserted-by":"publisher","DOI":"10.1257\/aer.20211063"},{"key":"e_1_3_5_16_2","unstructured":"Australian and New Zealand Hip Fracture Registry. Australian and New Zealand Hip Fracture Registry Annual Report of Hip Fracture Care; September 2021 Sydney. https:\/\/anzhfr.org\/wp-content\/uploads\/sites\/1164\/2021\/12\/ANZHFR-2021-Annual-Report_print-version.pdf (accessed December 2023)."},{"key":"e_1_3_5_17_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2113514"},{"key":"e_1_3_5_18_2","unstructured":"Australian Commission on Safety and Quality in Health Care. Delirium Clinical Care Standard. ACSQHC; 2021 Sydney. https:\/\/www.safetyandquality.gov.au\/our-work\/clinical-care-standards\/delirium-clinical-care-standard (accessed December 2023)."},{"key":"e_1_3_5_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2017.12.046"},{"key":"e_1_3_5_20_2","doi-asserted-by":"publisher","DOI":"10.1111\/aas.13168"},{"key":"e_1_3_5_21_2","doi-asserted-by":"publisher","DOI":"10.1111\/anae.15291"}],"container-title":["Anaesthesia and Intensive Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0310057X241275116","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/0310057X241275116","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0310057X241275116","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T09:13:02Z","timestamp":1777367582000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/0310057X241275116"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,6]]},"references-count":20,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2025,3]]}},"alternative-id":["10.1177\/0310057X241275116"],"URL":"https:\/\/doi.org\/10.1177\/0310057x241275116","relation":{},"ISSN":["0310-057X","1448-0271"],"issn-type":[{"value":"0310-057X","type":"print"},{"value":"1448-0271","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,6]]}}}