@article{f5393d685ea94a47a565f3b98df0db99,
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 = "Funding Information: We thank the 1600 older adults who volunteered to participate in the REGAIN trial, their families, and the many anesthesiologists, nurse anesthetists, orthopedic surgeons, and research staff members who helped to make this trial a success. This study was supported by a Patient-Centered Outcomes Research Institute Award (1406-18876). Sponsors had no role in the design or conduct of the study, the collection, management, analysis, or interpretation of data, the preparation, review, or approval of the manuscript, or the decision to submit the manuscript for publication. The views presented in this work are solely the responsibility of the authors and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute, its board of governors, or its methodology committee. Funding Information: We performed a post‐hoc secondary analysis of data from REGAIN. A pre‐specified statistical analysis plan (Appendix) was developed after carrying out the principal analyses for REGAIN but prior to undertaking the analyses reported here. The goals and design of the REGAIN trial are reported elsewhere, as are analyses for the primary and selected secondary outcomes. The University of Pennsylvania Institutional Review Board (IRB) approved the protocol and was the IRB of record for 11 sites; approval at other sites was via local IRB review. Written informed consent was obtained from the patient or a healthcare proxy for patients unable to provide consent. An independent Data and Safety Monitoring Board (DSMB), not blinded to treatment assignment, met at pre‐defined intervals to review the protocol, safety and adverse event data, and outcome data. The study was funded by the Patient Centered Outcomes Research Institute. 16–18 Publisher Copyright: {\textcopyright} 2023 the Alzheimer's Association.",
year = "2023",
month = sep,
doi = "10.1002/alz.13132",
language = "English (US)",
volume = "19",
pages = "4008--4019",
journal = "Alzheimer's and Dementia",
issn = "1552-5260",
publisher = "Elsevier Inc.",
number = "9",
}