Outcomes with spinal versus general anesthesia for patients with and without preoperative cognitive impairment: Secondary analysis of a randomized clinical trial

Kyra O'Brien; Rui Feng; Frederick Sieber; Edward R. Marcantonio; Ann Tierney; Jay Magaziner; Jeffrey L. Carson; Derek Dillane; Daniel I. Sessler; Diane Menio; Sabry Ayad; Trevor Stone; Steven Papp; Eric S. Schwenk; Mitchell Marshall; J. Douglas Jaffe; Charles Luke; Balram Sharma; Syed Azim; Robert Hymes; Ki Jinn Chin; Richard Sheppard; Barry Perlman; Joshua Sappenfield; Ellen Hauck; Mark A. Hoeft; Jason Karlawish; Samir Mehta; Derek J. Donegan; Annamarie Horan; Susan S. Ellenberg; Mark D. Neuman

doi:10.1002/alz.13132

Outcomes with spinal versus general anesthesia for patients with and without preoperative cognitive impairment: Secondary analysis of a randomized clinical trial

Kyra O'Brien
, Rui Feng
, Frederick Sieber
, Edward R. Marcantonio
, Ann Tierney
, Jay Magaziner
, Jeffrey L. Carson
, Derek Dillane
, Daniel I. Sessler
, Diane Menio
, Sabry Ayad
, Trevor Stone
, Steven Papp
, Eric S. Schwenk
, Mitchell Marshall
, J. Douglas Jaffe
, Charles Luke
, Balram Sharma
, Syed Azim
, Robert Hymes

Ki Jinn Chin, Richard Sheppard, Barry Perlman, Joshua Sappenfield, Ellen Hauck, Mark A. Hoeft, Jason Karlawish, Samir Mehta, Derek J. Donegan, Annamarie Horan, Susan S. Ellenberg, Mark D. Neuman

Anesthesiology

University of Pennsylvania
Johns Hopkins University
Harvard University
University of Maryland, Baltimore
Rutgers - The State University of New Jersey, New Brunswick
University of Alberta
Cleveland Clinic Foundation
The Center for Advocacy for the Rights and Interests of the Elderly
University of British Columbia
University of Ottawa
Thomas Jefferson University
New York University
Wake Forest University
University of Pittsburgh
USA
Department of Orthopedic Surgery
University of Toronto
Institute of Living
PeaceHealth Medical Group
University of Florida
Temple University
University of Vermont

Research output: Contribution to journal › Article › peer-review

10 Scopus citations

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.

Original language	English
Pages (from-to)	4008-4019
Number of pages	12
Journal	Alzheimer's and Dementia
Volume	19
Issue number	9
DOIs	https://doi.org/10.1002/alz.13132
State	Published - Sep 2023

Keywords

anesthesia
delirium
dementia
hip fracture
mild cognitive impairment
surgery

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10.1002/alz.13132

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O'Brien, K., Feng, R., Sieber, F., Marcantonio, E. R., Tierney, A., Magaziner, J., Carson, J. L., Dillane, D., Sessler, D. I., Menio, D., Ayad, S., Stone, T., Papp, S., Schwenk, E. S., Marshall, M., Jaffe, J. D., Luke, C., Sharma, B., Azim, S., ... Neuman, M. D. (2023). Outcomes with spinal versus general anesthesia for patients with and without preoperative cognitive impairment: Secondary analysis of a randomized clinical trial. Alzheimer's and Dementia, 19(9), 4008-4019. https://doi.org/10.1002/alz.13132

@article{80e79a1c1e23410d8ba3884d7bbdf8fe,

title = "Outcomes with spinal versus general anesthesia for patients with and without preoperative cognitive impairment: Secondary analysis of a randomized clinical trial",

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.",

keywords = "anesthesia, delirium, dementia, hip fracture, mild cognitive impairment, surgery",

author = "Kyra O'Brien and Rui Feng and Frederick Sieber and Marcantonio, \{Edward R.\} and Ann Tierney and Jay Magaziner and Carson, \{Jeffrey L.\} and Derek Dillane and Sessler, \{Daniel I.\} and Diane Menio and Sabry Ayad and Trevor Stone and Steven Papp and Schwenk, \{Eric S.\} and Mitchell Marshall and Jaffe, \{J. Douglas\} and Charles Luke and Balram Sharma and Syed Azim and Robert Hymes and Chin, \{Ki Jinn\} and Richard Sheppard and Barry Perlman and Joshua Sappenfield and Ellen Hauck and Hoeft, \{Mark A.\} and Jason Karlawish and Samir Mehta and Donegan, \{Derek J.\} and Annamarie Horan and Ellenberg, \{Susan S.\} and Neuman, \{Mark D.\}",

note = "Publisher Copyright: {\textcopyright} 2023 the Alzheimer's Association.",

year = "2023",

month = sep,

doi = "10.1002/alz.13132",

language = "English",

volume = "19",

pages = "4008--4019",

journal = "Alzheimer's and Dementia",

issn = "1552-5260",

number = "9",

}

O'Brien, K, Feng, R, Sieber, F, Marcantonio, ER, Tierney, A, Magaziner, J, Carson, JL, Dillane, D, Sessler, DI, Menio, D, Ayad, S, Stone, T, Papp, S, Schwenk, ES, Marshall, M, Jaffe, JD, Luke, C, Sharma, B, Azim, S, Hymes, R, Chin, KJ, Sheppard, R, Perlman, B, Sappenfield, J, Hauck, E, Hoeft, MA, Karlawish, J, Mehta, S, Donegan, DJ, Horan, A, Ellenberg, SS & Neuman, MD 2023, 'Outcomes with spinal versus general anesthesia for patients with and without preoperative cognitive impairment: Secondary analysis of a randomized clinical trial', Alzheimer's and Dementia, vol. 19, no. 9, pp. 4008-4019. https://doi.org/10.1002/alz.13132

TY - JOUR

T1 - Outcomes with spinal versus general anesthesia for patients with and without preoperative cognitive impairment

T2 - Secondary analysis of a randomized clinical trial

AU - O'Brien, Kyra

AU - Feng, Rui

AU - Sieber, Frederick

AU - Marcantonio, Edward R.

AU - Tierney, Ann

AU - Magaziner, Jay

AU - Carson, Jeffrey L.

AU - Dillane, Derek

AU - Sessler, Daniel I.

AU - Menio, Diane

AU - Ayad, Sabry

AU - Stone, Trevor

AU - Papp, Steven

AU - Schwenk, Eric S.

AU - Marshall, Mitchell

AU - Jaffe, J. Douglas

AU - Luke, Charles

AU - Sharma, Balram

AU - Azim, Syed

AU - Hymes, Robert

AU - Chin, Ki Jinn

AU - Sheppard, Richard

AU - Perlman, Barry

AU - Sappenfield, Joshua

AU - Hauck, Ellen

AU - Hoeft, Mark A.

AU - Karlawish, Jason

AU - Mehta, Samir

AU - Donegan, Derek J.

AU - Horan, Annamarie

AU - Ellenberg, Susan S.

AU - Neuman, Mark D.

PY - 2023/9

Y1 - 2023/9

N2 - 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.

AB - 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.

KW - anesthesia

KW - delirium

KW - dementia

KW - hip fracture

KW - mild cognitive impairment

KW - surgery

UR - https://www.scopus.com/pages/publications/85159075297

U2 - 10.1002/alz.13132

DO - 10.1002/alz.13132

M3 - Article

C2 - 37170754

AN - SCOPUS:85159075297

SN - 1552-5260

VL - 19

SP - 4008

EP - 4019

JO - Alzheimer's and Dementia

JF - Alzheimer's and Dementia

IS - 9

ER -

Outcomes with spinal versus general anesthesia for patients with and without preoperative cognitive impairment: Secondary analysis of a randomized clinical trial

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