The Analysis of Multiple Outcomes between General and Regional Anesthesia in Hip Fracture Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Abstract
:1. Introduction
2. Materials and Methods
2.1. Protocol
2.2. Search Strategy and Criteria
2.3. Screening
- Randomized controlled trials (RCTs);
- Adult patients with hip fractures undergoing surgical procedures;
- Comparing regional anesthesia versus general anesthesia;
- Reporting outcomes of interest: mortality (primary) and intra- and postoperative complications (secondary).
- Study designs other than RCTs;
- Pediatric studies;
- Not comparing regional to general anesthesia;
- Not reporting outcomes of interest.
2.4. Data Extraction and Statistical Methods
2.5. Quality Assessment
3. Results
3.1. Included Studies
3.2. Mortality
3.3. Intraoperative Hypotension
3.4. Cardiac and Cerebrovascular Complications
3.5. Vascular Complications
3.6. Acute Kidney Disease
3.7. Postoperative Pneumonia
3.8. Intraoperative Blood Loss (mL)
3.9. Perioperative Blood Transfusion
3.10. Duration of Hospital Stay (Days)
3.11. Quality Assessment
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Gullberg, B.; Johnell, O.; Kanis, J.A. World-Wide Projections for Hip Fracture. Osteoporos. Int. 1997, 7, 407–413. [Google Scholar] [CrossRef] [PubMed]
- Haugan, K.; Johnsen, L.G.; Basso, T.; Foss, O.A. Mortality and Readmission Following Hip Fracture Surgery: A Retrospective Study Comparing Conventional and Fast-Track Care. BMJ Open 2017, 7, e015574. [Google Scholar] [CrossRef] [PubMed]
- White, S.M.; Griffiths, R. Projected Incidence of Proximal Femoral Fracture in England: A Report from the NHS Hip Fracture Anaesthesia Network (HIPFAN). Injury 2011, 42, 1230–1233. [Google Scholar] [CrossRef] [PubMed]
- Johansen, A.; Tsang, C.; Boulton, C.; Wakeman, R.; Moppett, I. Understanding Mortality Rates after Hip Fracture Repair Using ASA Physical Status in the National Hip Fracture Database. Anaesthesia 2017, 72, 961–966. [Google Scholar] [CrossRef] [PubMed]
- White, S.M.; Moppett, I.K.; Griffiths, R.; Johansen, A.; Wakeman, R.; Boulton, C.; Plant, F.; Williams, A.; Pappenheim, K.; Majeed, A.; et al. Secondary Analysis of Outcomes after 11,085 Hip Fracture Operations from the Prospective UK Anaesthesia Sprint Audit of Practice (ASAP-2). Anaesthesia 2016, 71, 506–514. [Google Scholar] [CrossRef] [PubMed]
- Le Manach, Y.; Collins, G.; Bhandari, M.; Bessissow, A.; Boddaert, J.; Khiami, F.; Chaudhry, H.; De Beer, J.; Riou, B.; Landais, P.; et al. Outcomes After Hip Fracture Surgery Compared with Elective Total Hip Replacement. JAMA 2015, 314, 1159. [Google Scholar] [CrossRef]
- Haentjens, P. Meta-Analysis: Excess Mortality After Hip Fracture Among Older Women and Men. Ann. Intern. Med. 2010, 152, 380. [Google Scholar] [CrossRef]
- White, S.M.; Griffiths, R. Problems Defining ‘Hypotension’ in Hip Fracture Anaesthesia. Br. J. Anaesth. 2019, 123, e528–e529. [Google Scholar] [CrossRef]
- Wesselink, E.M.; Kappen, T.H.; Torn, H.M.; Slooter, A.J.C.; Van Klei, W.A. Intraoperative Hypotension and the Risk of Postoperative Adverse Outcomes: A Systematic Review. Br. J. Anaesth. 2018, 121, 706–721. [Google Scholar] [CrossRef]
- Biboulet, P.; Jourdan, A.; Van Haevre, V.; Morau, D.; Bernard, N.; Bringuier, S.; Capdevila, X. Hemodynamic Profile of Target-Controlled Spinal Anesthesia Compared with 2 Target-Controlled General Anesthesia Techniques in Elderly Patients with Cardiac Comorbidities. Reg. Anesth. Pain Med. 2012, 37, 433–440. [Google Scholar] [CrossRef]
- Futier, E.; Lefrant, J.-Y.; Guinot, P.-G.; Godet, T.; Lorne, E.; Cuvillon, P.; Bertran, S.; Leone, M.; Pastene, B.; Piriou, V.; et al. Effect of Individualized vs Standard Blood Pressure Management Strategies on Postoperative Organ Dysfunction Among High-Risk Patients Undergoing Major Surgery: A Randomized Clinical Trial. JAMA 2017, 318, 1346. [Google Scholar] [CrossRef] [PubMed]
- La Via, L.; Astuto, M.; Dezio, V.; Muscarà, L.; Palella, S.; Zawadka, M.; Vignon, P.; Sanfilippo, F. Agreement between Subcostal and Transhepatic Longitudinal Imaging of the Inferior Vena Cava for the Evaluation of Fluid Responsiveness: A Systematic Review. J. Crit. Care 2022, 71, 154108. [Google Scholar] [CrossRef] [PubMed]
- Sanfilippo, F.; La Via, L.; Dezio, V.; Santonocito, C.; Amelio, P.; Genoese, G.; Astuto, M.; Noto, A. Assessment of the Inferior Vena Cava Collapsibility from Subcostal and Trans-Hepatic Imaging Using Both M-Mode or Artificial Intelligence: A Prospective Study on Healthy Volunteers. Intensive Care Med. Exp. 2023, 11, 15. [Google Scholar] [CrossRef] [PubMed]
- Juri, T.; Suehiro, K.; Kimura, A.; Mukai, A.; Tanaka, K.; Yamada, T.; Mori, T.; Nishikawa, K. Impact of Continuous Non-Invasive Blood Pressure Monitoring on Hemodynamic Fluctuation during General Anesthesia: A Randomized Controlled Study. J. Clin. Monit. Comput. 2018, 32, 1005–1013. [Google Scholar] [CrossRef] [PubMed]
- White, S.M.; Moppett, I.K.; Griffiths, R. Outcome by Mode of Anaesthesia for Hip Fracture Surgery. An Observational Audit of 65 535 Patients in a National Dataset. Anaesthesia 2014, 69, 224–230. [Google Scholar] [CrossRef] [PubMed]
- Maxwell, B.G.; Spitz, W.; Porter, J. Association of Increasing Use of Spinal Anesthesia in Hip Fracture Repair with Treating an Aging Patient Population. JAMA Surg. 2020, 155, 167. [Google Scholar] [CrossRef]
- Boddaert, J.; Raux, M.; Khiami, F.; Riou, B. Perioperative Management of Elderly Patients with Hip Fracture. Anesthesiology 2014, 121, 1336–1341. [Google Scholar] [CrossRef]
- O’Donnell, C.M.; Black, N.; McCourt, K.C.; McBrien, M.E.; Clarke, M.; Patterson, C.C.; Blackwood, B.; McAuley, D.F.; Shields, M.O. Development of a Core Outcome Set for Studies Evaluating the Effects of Anaesthesia on Perioperative Morbidity and Mortality Following Hip Fracture Surgery. Br. J. Anaesth. 2019, 122, 120–130. [Google Scholar] [CrossRef]
- Messina, A.; La Via, L.; Milani, A.; Savi, M.; Calabrò, L.; Sanfilippo, F.; Negri, K.; Castellani, G.; Cammarota, G.; Robba, C.; et al. Spinal Anesthesia and Hypotensive Events in Hip Fracture Surgical Repair in Elderly Patients: A Meta-Analysis. J. Anesth. Analg. Crit. Care 2022, 2, 19. [Google Scholar] [CrossRef]
- Devisme, V.; Picart, F.; Lejouan, R.; Legrand, A.; Savry, C.; Morin, V. Combined Lumbar and Sacral Plexus Block Compared with Plain Bupivacaine Spinal Anesthesia for Hip Fractures in the Elderly. Reg. Anesth. Pain Med. 2000, 25, 158–162. [Google Scholar] [CrossRef]
- Johnston, D.F.; Stafford, M.; McKinney, M.; Deyermond, R.; Dane, K. Peripheral Nerve Blocks with Sedation Using Propofol and Alfentanil Target-Controlled Infusion for Hip Fracture Surgery: A Review of 6 Years in Use. J. Clin. Anesth. 2016, 29, 33–39. [Google Scholar] [CrossRef]
- Page, M.J.; McKenzie, J.E.; Bossuyt, P.M.; Boutron, I.; Hoffmann, T.C.; Mulrow, C.D.; Shamseer, L.; Tetzlaff, J.M.; Akl, E.A.; Brennan, S.E.; et al. The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews. BMJ 2021, 372, n71. [Google Scholar] [CrossRef] [PubMed]
- Luo, D.; Wan, X.; Liu, J.; Tong, T. Optimally Estimating the Sample Mean from the Sample Size, Median, Mid-Range, and/or Mid-Quartile Range. Stat. Methods Med. Res. 2018, 27, 1785–1805. [Google Scholar] [CrossRef] [PubMed]
- Wan, X.; Wang, W.; Liu, J.; Tong, T. Estimating the Sample Mean and Standard Deviation from the Sample Size, Median, Range and/or Interquartile Range. BMC Med. Res. Methodol. 2014, 14, 135. [Google Scholar] [CrossRef] [PubMed]
- Sterne, J.A.C.; Savović, J.; Page, M.J.; Elbers, R.G.; Blencowe, N.S.; Boutron, I.; Cates, C.J.; Cheng, H.-Y.; Corbett, M.S.; Eldridge, S.M.; et al. RoB 2: A Revised Tool for Assessing Risk of Bias in Randomised Trials. BMJ 2019, 366, l4898. [Google Scholar] [CrossRef] [PubMed]
- Guyatt, G.H.; Oxman, A.D.; Schünemann, H.J.; Tugwell, P.; Knottnerus, A. GRADE Guidelines: A New Series of Articles in the Journal of Clinical Epidemiology. J. Clin. Epidemiol. 2011, 64, 380–382. [Google Scholar] [CrossRef] [PubMed]
- Bigler, D.; Adelhøj, B.; Petring, O.U.; Pederson, N.O.; Busch, P.; Kalhke, P. Mental Function and Morbidity after Acute Hip Surgery during Spinal and General Anaesthesia. Anaesthesia 1985, 40, 672–676. [Google Scholar] [CrossRef]
- Davis, F.M.; Laurenson, V.G. Spinal Anaesthesia or General Anaesthesia for Emergency Hip Surgery in Elderly Patients. Anaesth. Intensive Care 1981, 9, 352–358. [Google Scholar] [CrossRef]
- Davis, F.M.; Woolner, D.F.; Frampton, C.; Wilkinson, A.; Grant, A.; Harrison, R.T.; Roberts, M.T.S.; Thadaka, R. Prospective, Multi-Centre Trial of Mortality Following General or Spinal Anaesthesia for Hip Fracture Surgery in the Elderly. Br. J. Anaesth. 1987, 59, 1080–1088. [Google Scholar] [CrossRef]
- Juelsgaard, P.; Sand, N.P.R.; Felsby, S.; Dalsgaard, J.; Jakobsen, K.B.; Brink, O.; Carlsson, P.S.; Thygesen, K. Perioperative Myocardial Ischaemia in Patients Undergoing Surgery for Fractured Hip Randomized to Incremental Spinal, Single-Dose Spinal or General Anaesthesia. Eur. J. Anaesthesiol. 1998, 15, 656–663. [Google Scholar] [CrossRef]
- Li, T.; Li, J.; Yuan, L.; Wu, J.; Jiang, C.; Daniels, J.; Mehta, R.L.; Wang, M.; Yeung, J.; Jackson, T.; et al. Effect of Regional vs General Anesthesia on Incidence of Postoperative Delirium in Older Patients Undergoing Hip Fracture Surgery: The RAGA Randomized Trial. JAMA 2022, 327, 50. [Google Scholar] [CrossRef] [PubMed]
- Mckenzie, P.J.; Wishart, H.Y.; Dewar, K.M.S.; Gray, I.; Smith, G. Comparison of the Effects of Spinal Anaesthesia and General Anaesthesia on Postoperative Oxygenation and Perioperative Mortality. Br. J. Anaesth. 1980, 52, 49–54. [Google Scholar] [CrossRef]
- Mckenzie, P.J.; Wishart, H.Y.; Smith, G. Long-Term Outcome after Repair of Fractured Neck of Femur. Br. J. Anaesth. 1984, 56, 581–585. [Google Scholar] [CrossRef] [PubMed]
- McKenzie, P.J.; Wishart, H.Y.; Gray, I.; Smith, G. Effects of Anaesthetic Technique on Deep Vein Thrombosis. Br. J. Anaesth. 1985, 57, 853–857. [Google Scholar] [CrossRef]
- McLAREN, A.D.; Stockwell, M.C.; Reid, V.T. Anaesthetic Techniques for Surgical Correction of Fractured Neck of Femur.: A Comparative Study of Spinal and General Anaesthesia in the Elderly. Anaesthesia 1978, 33, 10–14. [Google Scholar] [CrossRef]
- Messina, A.; Frassanito, L.; Colombo, D.; Vergari, A.; Draisci, G.; Della Corte, F.; Antonelli, M. Hemodynamic Changes Associated with Spinal and General Anesthesia for Hip Fracture Surgery in Severe ASA III Elderly Population: A Pilot Trial. Minerva Anestesiol. 2013, 79, 1021–1029. [Google Scholar] [PubMed]
- Neuman, M.D.; Feng, R.; Carson, J.L.; Gaskins, L.J.; Dillane, D.; Sessler, D.I.; Sieber, F.; Magaziner, J.; Marcantonio, E.R.; Mehta, S.; et al. Spinal Anesthesia or General Anesthesia for Hip Surgery in Older Adults. N. Engl. J. Med. 2021, 385, 2025–2035. [Google Scholar] [CrossRef] [PubMed]
- Parker, M.J.; Griffiths, R. General versus Regional Anaesthesia for Hip Fractures. A Pilot Randomised Controlled Trial of 322 Patients. Injury 2015, 46, 1562–1566. [Google Scholar] [CrossRef]
- Svartling, N.; Lehtinen, A.-M.; Tarkkanen, L. The Effect of Anaesthesia on Changes in Blood Pressure and Plasma Cortisol Levels Induced by Cementation with Methylmethacrylate. Acta Anaesthesiol. Scand. 1986, 30, 247–252. [Google Scholar] [CrossRef]
- Tzimas, P.; Samara, E.; Petrou, A.; Korompilias, A.; Chalkias, A.; Papadopoulos, G. The Influence of Anesthetic Techniques on Postoperative Cognitive Function in Elderly Patients Undergoing Hip Fracture Surgery: General vs Spinal Anesthesia. Injury 2018, 49, 2221–2226. [Google Scholar] [CrossRef]
- White, I.W.C.; Chappell, W.A. Anaesthesia for Surgical Correction of Fractured Femoral Neck A Comparison of Three Techniques. Anaesthesia 1980, 35, 1107–1110. [Google Scholar] [CrossRef] [PubMed]
- Neuman, M.D.; Silber, J.H.; Elkassabany, N.M.; Ludwig, J.M.; Fleisher, L.A. Comparative Effectiveness of Regional versus General Anesthesia for Hip Fracture Surgery in Adults. Anesthesiology 2012, 117, 72–92. [Google Scholar] [CrossRef] [PubMed]
- Ahn, E.J.; Kim, H.J.; Kim, K.W.; Choi, H.R.; Kang, H.; Bang, S.R. Comparison of General Anaesthesia and Regional Anaesthesia in Terms of Mortality and Complications in Elderly Patients with Hip Fracture: A Nationwide Population-Based Study. BMJ Open 2019, 9, e029245. [Google Scholar] [CrossRef] [PubMed]
- Rosa, R.G.; Falavigna, M.; Da Silva, D.B.; Sganzerla, D.; Santos, M.M.S.; Kochhann, R.; De Moura, R.M.; Eugênio, C.S.; Haack, T.D.S.R.; Barbosa, M.G.; et al. Effect of Flexible Family Visitation on Delirium Among Patients in the Intensive Care Unit: The ICU Visits Randomized Clinical Trial. JAMA 2019, 322, 216. [Google Scholar] [CrossRef] [PubMed]
- Chu, C.-C.; Weng, S.-F.; Chen, K.-T.; Chien, C.-C.; Shieh, J.-P.; Chen, J.-Y.; Wang, J.-J. Propensity Score–Matched Comparison of Postoperative Adverse Outcomes between Geriatric Patients Given a General or a Neuraxial Anesthetic for Hip Surgery. Anesthesiology 2015, 123, 136–147. [Google Scholar] [CrossRef] [PubMed]
- Neuman, M.D.; Rosenbaum, P.R.; Ludwig, J.M.; Zubizarreta, J.R.; Silber, J.H. Anesthesia Technique, Mortality, and Length of Stay After Hip Fracture Surgery. JAMA 2014, 311, 2508. [Google Scholar] [CrossRef] [PubMed]
- Mounet, B.; Choquet, O.; Swisser, F.; Biboulet, P.; Bernard, N.; Bringuier, S.; Capdevila, X. Impact of Multiple Nerves Blocks Anaesthesia on Intraoperative Hypotension and Mortality in Hip Fracture Surgery Intermediate-Risk Elderly Patients: A Propensity Score-Matched Comparison with Spinal and General Anaesthesia. Anaesth. Crit. Care Pain Med. 2021, 40, 100924. [Google Scholar] [CrossRef]
- Viderman, D.; Aubakirova, M.; Nabidollayeva, F.; Yegembayeva, N.; Bilotta, F.; Badenes, R.; Abdildin, Y. Effect of Ketamine on Postoperative Neurocognitive Disorders: A Systematic Review and Meta-Analysis. J. Clin. Med. 2023, 12, 4314. [Google Scholar] [CrossRef]
- Sanfilippo, F.; La Via, L.; Tigano, S.; Morgana, A.; Rosa, V.; Astuto, M. Trial Sequential Analysis: The Evaluation of the Robustness of Meta-Analyses Findings and the Need for Further Research. EuroMediterr. Biomed. J. 2021, 16, 104–107. [Google Scholar] [CrossRef]
- Cassai, A.D.; Pasin, L.; Boscolo, A.; Salvagno, M.; Navalesi, P. Trial Sequential Analysis: Plain and Simple. Korean J. Anesthesiol. 2020, 74, 363–365. [Google Scholar] [CrossRef]
First Author, Year | Country | Groups | Study Outcomes | Age (Mean ± SD) | N of Patients: Total (I/C) | Local Anesthetic |
---|---|---|---|---|---|---|
Bigler, 1985 [27] | NG | GA | Prim.—postoperative mental function and morbidity | 80.1 ± 1.6 | 40 (20/20) | SA: 3 mL bupivacaine 0.75% |
SA | 77.6 ± 2.3 | |||||
Davis, 1981 [28] | New Zealand | GA | Prim.—morbidity and mortality | 81 ± 8.2 | 132 (64/68) | SA: tetracaine 0.5% in 6% dextrose with adrenaline 1:100,000 without barbotage in 51 patients Hyperbaric cinchocaine 0.5% in 6% dextrose in 13 patients |
SA | 78 ± 8.6 | |||||
Davis, 1987 [29] | New Zealand | GA | Prim.—mortality | 79.5 ± 8.8 | 538 (259/279) | SA: tetracaine, nupercaine or bupivacaine (optional), hyper/iso-baric |
SA | ||||||
Juelsgaard, 1998 [30] | Denmark | GA | Prim.—incidence of myocardial ischemia in atherosclerotic patients | 85.7 (72–94) | 43 (14/15/14) | ISA: Bupivacaine 0.5% plain SDSA: 2.5 mL bupivacaine plain |
ISA | 82.2 (65–99) | |||||
SDSA | 79.6 (72–92) | |||||
Li, 2021 [31] | China | GA | Prim.—delirium within 7 days. Sec.—delirium characteristics, pain intensity in week 1, death at 30 days, hospital LoS, complications, and long-term and financial outcomes | 77 (72–82) 77 (71–82) | 942 (471/471) | SA: ropivacaine EA, NB: ropivacaine, bupivacaine, lidocaine |
SA | ||||||
EA | ||||||
NB | ||||||
McKenzie, 1980 [32] | UK | GA | Prim.—postoperative arterial oxygenation and intraoperative mortality | 76.8 ± 1.38 | 100 (49/51) | SA: 1.3–1.5 mL hyperbaric cinchocaine 0.5% |
SA | 74.5 ± 2.29 | |||||
McKenzie, 1984 [33] | UK | GA | Prim.—mortality at 1 year | 74.2 ± 1.7 | 150 (75/75) | SA: 1.3–1.5 mL hyperbaric 0.5% cinchocaine |
SA | 75.4 ± 1.4 | |||||
McKenzie, 1985 [34] | UK | GA | Prim.—incidence of deep vein thrombosis and pulmonary embolism | 73.9 ± 4.1 | 40 (20/20) | SA: 1.2–1.5 mL hyperbaric conchocaine |
SA | 72.3 ± 2.8 | |||||
McLaren, 1978 [35] | UK | GA | Prim.—mortality and morbidity | 76 ± 9.7 | 55 (26/29) | SA: 0.5 mL hyperbaric cinchocaine (0.5% in 6% dextrose) |
SA | 75.6 ± 10.3 | |||||
Messina, 2013 [36] | Italy | GA | Prim.—hemodynamic response | 81.8 ± 6.3 | 20 (10/10) | SA: 7.5 mg levobupivacaine diluted from 7.5 mg/mL with 2 mL distilled water + preservative-free sufentanil 5 µg |
SA | 83.9 ± 9.4 | |||||
Neuman, 2021 [37] | USA, Canada | GA | Prim—death or inability to walk independently at 60 days after randomization | 77.7 ± 10.7 | 1572 (782/790) | Varied across study sites |
SA | 78.4 ± 10.6 | |||||
Parker, 2015 [38] | UK | GA | Prim.—mortality | 82.9 (range 52–105) | 322 (158/164) | At the discretion of the anesthetist |
SA | 83.0 (range 59–99) | |||||
Svartling, 1986 [39] | Finland | GA | Prim.—arterial blood, pressure, arterial oxygen tension, plasma levels of cortisol | 79.6 ± 2.1 | 30 (15/15) | SA: 3 mL isobaric bupivacaine hydrochloride 0.5% |
SA | 75.1 ± 1.1 | |||||
Tzimas, 2018 [40] | Greece | GA | Prim.—POCD at 30 days after surgery, possible differences Sec.—delirium on days 1, 2, 3, 4 | 77.11 ± 6.5 | 70 (37/33) | SA: fentanyl 20 mcg + ropivacaine 0.75% based on somatometric characteristics |
SA | 75.09 ± 6.08 | |||||
White, 1980 [41] | South Africa | GA | Prim.—pre, intra-, and postoperative events and mortality | 78 ± 7.8 | 56 (20/20/16) | SA: hyperbaric cinchocaine 0.6–0.8 mL |
SA | 80 ± 9.1 | |||||
PCB | 78 ± 7.3 |
Study (Author, Year) | Risk of Bias Arising from the Randomization Process | Risk of Bias Due to Deviations from the Intended Interventions | Missing Outcome Data | Risk of Bias in Measurement of the Outcome | Risk of Bias in Selection of the Reported Result | Overall Risk of Bias |
---|---|---|---|---|---|---|
Davis et al., 1981 [28] | Some concerns | Low risk | Low risk | Some concerns | Low risk | Some concerns |
Bigler et al., 1985 [27] | Some concerns | Low risk | Low risk | Some concerns | Low risk | Some concerns |
Davis et al., 1987 [29] | Some concerns | Low risk | Low risk | Some concerns | Low risk | Some concerns |
Juelsgaard et al., 1998 [30] | Some concerns | Low risk | Low risk | Some concerns | Low risk | Some concerns |
Mckenzie et al., 1980 [32] | Some concerns | Low risk | Low risk | Some concerns | Low risk | Some concerns |
Mckenzie et al., 1984 [33] | Some concerns | Low risk | Low risk | Some concerns | Low risk | Some concerns |
Neuman et al., 2021 [37] | Low risk | Low risk | Some concerns | Some concerns | Low risk | Some concerns |
Parker et al., 2015 [38] | Low risk | Some concerns | Low risk | Low risk | Low risk | Some concerns |
White et al., 1980 [41] | Some concerns | Low risk | Low risk | Some concerns | Low risk | Some concerns |
Messina et al., 2013 [36] | Low risk | Low risk | Low risk | Some concerns | Low risk | Some concerns |
Svartling et al., 1986 [39] | Some concerns | Low risk | Low risk | Some concerns | Low risk | Some concerns |
McLaren et al., 1978 [35] | Some concerns | Low risk | Low risk | Some concerns | Low risk | Some concerns |
Li et al., 2022 [31] | Low risk | Low risk | Low risk | Some concerns | Low risk | Some concerns |
Tzimas et al., 2018 [40] | Some concerns | Low risk | Low risk | Some concerns | Low risk | Some concerns |
McKenzie et al., 1985 [34] | Some concerns | Low risk | Low risk | Some concerns | Low risk | Some concerns |
N of Studies | Design | N of Patients | Effect | Overall Quality | ||
---|---|---|---|---|---|---|
Outcome | RA | GA | Relative Risk/Mean Difference [95% CI] | |||
Death | 10 | RCT | 1918 | 1958 | 1.42 [0.96, 2.10] | Low a ⨁⨁⊖⊖ |
Intraoperative hypotension | 6 | RCT | 564 | 531 | 1.24 [0.59, 2.60] | Low a ⨁⨁⊖⊖ |
Myocardial infarction | 6 | RCT | 1759 | 1793 | 1.23 [0.54, 2.82] | Very low b ⨁⊖⊖⊖ |
Cardiac failure | 3 | RCT | 1199 | 1233 | 0.85 [0.23, 3.07] | Very low b ⨁⊖⊖⊖ |
Cerebrovascular accident | 3 | RCT | 492 | 518 | 0.60 [0.03, 12.83] | Very low b ⨁⊖⊖⊖ |
Deep vein thrombosis | 3 | RCT | 252 | 242 | 1.36 [0.43, 4.29] | Very low b ⨁⊖⊖⊖ |
Postoperative pulmonary embolus | 5 | RCT | 1294 | 1328 | 1.59 [0.61, 4.14] | Very low b ⨁⊖⊖⊖ |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Viderman, D.; Aubakirova, M.; Nabidollayeva, F.; Abdildin, Y.G. The Analysis of Multiple Outcomes between General and Regional Anesthesia in Hip Fracture Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J. Clin. Med. 2023, 12, 7513. https://doi.org/10.3390/jcm12247513
Viderman D, Aubakirova M, Nabidollayeva F, Abdildin YG. The Analysis of Multiple Outcomes between General and Regional Anesthesia in Hip Fracture Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Journal of Clinical Medicine. 2023; 12(24):7513. https://doi.org/10.3390/jcm12247513
Chicago/Turabian StyleViderman, Dmitriy, Mina Aubakirova, Fatima Nabidollayeva, and Yerkin G. Abdildin. 2023. "The Analysis of Multiple Outcomes between General and Regional Anesthesia in Hip Fracture Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials" Journal of Clinical Medicine 12, no. 24: 7513. https://doi.org/10.3390/jcm12247513
APA StyleViderman, D., Aubakirova, M., Nabidollayeva, F., & Abdildin, Y. G. (2023). The Analysis of Multiple Outcomes between General and Regional Anesthesia in Hip Fracture Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Journal of Clinical Medicine, 12(24), 7513. https://doi.org/10.3390/jcm12247513