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Background:
Systematic Review

The Effect of General Versus Neuraxial Anaesthesia on Bleeding and Thrombotic Outcomes in Neck of Femur Fracture Surgery: A Meta-Analysis

by
Alexandra Lyons
*,
Nathan Yii
,
Leigh White
,
Matthew Bright
and
Gina Velli
The Department of Anaesthesia and Pain Medicine, Sunshine Coast University Hospital, 6 Doherty Street, Birtinya, QLD 4575, Australia
*
Author to whom correspondence should be addressed.
Anesth. Res. 2025, 2(4), 25; https://doi.org/10.3390/anesthres2040025
Submission received: 17 August 2025 / Revised: 8 September 2025 / Accepted: 22 October 2025 / Published: 11 November 2025
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Abstract

Background: Hip fracture surgery in elderly patients carries significant risks of both bleeding and thrombotic complications. Anaesthetists frequently face a dilemma between neuraxial anaesthesia, which may reduce thrombotic risk but is often limited by contraindications, and general anaesthesia, which is widely applicable but may exacerbate bleeding. Previous reviews have not specifically addressed bleeding and thrombotic outcomes, leaving a critical gap that this meta-analysis seeks to answer. Study objective: To evaluate the effect of neuraxial anaesthesia compared to general anaesthesia on the incidence of bleeding and thrombotic complications in acute neck of femur fracture surgery. Methods: Relevant studies comparing neuraxial and general anaesthetic for hip fracture surgery were searched for through Medline, Embase, Scopus, CINAHL and PubMed. Inclusion criteria were randomised control trials of hip fracture surgery patients aged >16 years with relevant outcome data. In total, 24 randomised control trials were included, with 5479 patients. A meta-analysis was performed using RevMan 5.4 software. The study was registered with PROSPERO ID: CRD42022348039. Outcome measurement: Primary outcomes were intra-operative blood loss, intra- or post-operative blood transfusion and post-operative deep vein thrombosis. Secondary outcomes were post-operative pulmonary embolism, post-operative myocardial infarction and post-operative stroke. Results: Neuraxial anaesthesia reduced deep vein thrombosis incidence by 45% and reduced blood loss by 58 mL, both of which reached statistical significance (p < 0.05). Albeit not reaching statistical significance, neuraxial anaesthesia also had a 35% relative risk reduction in myocardial infarction, and a 35% relative decrease in stroke in current studies published after 2010. Despite practise evolution over the decades, protective neuraxial trends have remained. Conclusions: Patients undergoing acute hip fracture surgery under general anaesthesia have higher volumes of blood loss, without requiring increased blood transfusion. General anaesthesia is also associated with higher thrombotic complications, with a 45% increased relative risk of deep vein thrombosis, compared to neuraxial anaesthesia. Multi-modal thromboprophylaxis is important, as up to a third of DVT cases occur in the non-operative leg. In frail patients with a low cardiopulmonary reserve for bleeding or in high-thrombotic-risk patients, extra consideration and optimisation for neuraxial technique is advised. Future studies on comorbidities and operation type may reveal a subgroup of patients which would benefit from a specific anaesthetic type.

1. Introduction

The average incidence of hip fractures exceeds 40 per day in Australia [1], 190 per day in the United Kingdom [2] and 700 per day in America [3]. Hip fractures are a significant cause for morbidity and mortality, particularly in the elderly, with 1 in 4 patients aged over 45 dying within one year of hip fracture [4]. Early operative repair restores mobility and provides analgesia, improving quality of life and survival when compared with non-operative conservative management [5]. Despite the prevalence, there remains no clear consensus on the optimal anaesthetic technique for hip fracture surgery, and practice varies widely between institutions and across countries [6].
For the anaesthetist, the decision between neuraxial (spinal/epidural) and general anaesthesia (GA) is not trivial. These patients are typically high-risk, with frailty and limited cardiopulmonary reserve [4]. Neuraxial anaesthesia offers potential advantages, including reduced sympathetic tone, attenuated stress response and lower thrombotic risk through improved lower limb blood flow [7]. Yet, it is often precluded by recent anticoagulant exposure, spinal pathology or the inability to position safely, according to analgesic requirements. While the induction of GA offers a speed advantage, it comes with greater haemodynamic instability [8], increasing the risk of myocardial stress, cerebral hypoperfusion and delirium [9].
The dilemma between anaesthetic approaches is confounded by the unique bleeding and thrombotic profile of hip fracture surgery [10]. The rich vascularity of the proximal femur and inability to apply a tourniquet predispose patients to substantial blood loss [11]. Blood transfusions in frail patients increase the risk of morbidity with delirium, fluid overload and prolonged length of stay [12]. At the same time, hip fracture surgery is an independent risk factor for venous thromboembolism (VTE) [10], in a population already vulnerable to adverse cardiac events and immobilisation-related thrombosis [13]. These competing risks of bleeding and thrombosis make the choice of anaesthetic technique clinically consequential.
Large randomised trials (REGAIN and RAGA) and meta-analyses have primarily evaluated mortality, delirium and functional recovery [14,15]. While these trials suggested no material difference between neuraxial and GA for global outcomes, bleeding and thrombotic events were secondary endpoints, often inconsistently defined and underpowered. The most cited synthesis, the 2016 Cochrane review, likewise did not meta-analyse intra-operative blood loss or transfusion, leaving this clinically important question unanswered [2].
Therefore, this meta-analysis specifically addresses the anaesthetist’s clinical dilemma: when facing a frail patient with an acute hip fracture, does choosing neuraxial or general anaesthesia meaningfully alter bleeding and thrombotic outcomes? By targeting intra-operative blood loss, transfusion requirements and DVT as primary endpoints, and myocardial infarction, stroke and pulmonary embolism as secondary outcomes, this study provides further data to enable clinicians to make evidence-based decisions where uncertainty persists. The findings will help clinicians weigh the competing risks of bleeding and thrombosis, supporting safer, more individualised anaesthetic choices in a vulnerable population.

2. Method

2.1. Study Registration

The protocol for this systematic review was registered with PROSPERO (CRD42022348039).

2.2. Search Strategy

An electronic search of studies was performed on Medline, Embase, Scopus, CINAHL and PubMed, up to the date of 14 February 2023. Two independent reviewers (AL, NY) screened the search results for the study inclusion criteria. Following the identification of eligible studies for inclusion, a manual screen of reference lists and citations was also performed.

2.3. Types of Studies

Only randomised control trials were eligible for inclusion. There were no limitations placed on the date of publication, language or geographical location. Cohort studies, case studies, case series and laboratory studies were excluded.

2.4. Types of Participants

Studies were considered if they included patients who had hip fracture surgery aged >16 years.

2.5. Types of Intervention

Studies were included if they directly compared neuraxial (spinal or epidural single-shot, continuous infusion or combined) and general anaesthetic. Neuraxial anaesthesia included single-dose or continuous neuraxial anaesthesia with or without sedation. General anaesthesia included inhalational or intravenous techniques with or without associated regional analgesia.

2.6. Type of Outcome Measures

Primary outcomes included intra-operative blood loss, intra- or post-operative blood transfusion and post-operative deep vein thrombosis. Secondary outcomes included post-operative pulmonary embolism, post-operative myocardial infarction and post-operative stroke.

2.7. Data Extraction

Three reviewers, AL, NY and MB, independently screened abstracts and titles. Disagreements were resolved by discussion between AL and NY. When a consensus was not reached, LW made the final determination. Duplicate publications and pilot trials were removed. Data analysis was performed in Review Manager (Cochrane) software. Reported variables (range, interquartile range and standard error of the mean) were converted to standard deviation via standardised formulae [16].

2.8. Data Analysis

The Cochrane Handbook of Systematic Reviews was used to assess bias. A study was deemed to be high quality if it was assessed as low risk across all domains.

2.9. Strategy for Data Synthesis

The meta-analysis was performed using Review Manager 5.4 (Cochrane). For dichotomous variables, the Mantel–Haenszel test was used with random effects modelling. For the continuous variable (blood loss), the mean difference was calculated via inverse variance modelling. In the event of a study having zero events for both treatment arms, a continuity correction of 0.5 was applied using SPSS version 29 (IBM Statistics) to detect any changes to the initial risk ratio calculated in Review Manager 5.4. The I2 squared statistic was used to quantify heterogeneity, with values categorised as low (<25%), moderate (25–75%) and high (>75%) heterogeneity.

2.10. Analysis of Subgroups or Subsets

We reported the pooled effect size as risk ratio estimates for all the studies, as a measure of association between the anaesthetic type and adverse event. A subgroup analysis of studies with conventional methods was performed, excluding drugs and techniques no longer used (e.g., halothane).

2.11. Assessment of the Certainty of Evidence

The certainty of evidence was manually performed in accordance with the Cochrane Handbook of Systematic Reviews of Interventions [17].

3. Results

3.1. Search Results

A total of 24 studies were included in the final quantitative analysis (Figure 1). The initial search yielded 367 studies for review. Following title screening, 51 full texts were assessed for study inclusion. In total, 24 studies were included and contained a total of 5479 patients. Patient and study characteristics are outlined in Figure 2. Detailed study characteristics are included in Supplementary Figure S3. If patients had different methods for general anaesthesia, their results were pooled. A risk bias assessment for all included outcomes was performed (Supplementary Figures S1, S4 and S5).

3.2. Primary Outcomes

Intra-operative blood loss was evaluated in 14 studies (n = 1765). The pooled results indicate a reduction in blood loss of 57.91 mL (p = 0.01, 95%CI = −102.87 to −12.95 mL) with neuraxial anaesthesia (Figure 3).
The requirement for intra- or post-operative blood transfusion was assessed by six studies (n = 3211). The pooled risk ratio of 0.93 (p = 0.29, 95%CI = 0.82 to 1.06) was not statistically significant (Figure 3).
Post-operative deep vein thrombosis (DVT) was assessed by seven studies (n = 718). The pooled risk ratio of 0.55 indicates a statistically significant reduction in DVT by 45% (p = 0.0002, 95%CI = 0.40 to 0.76) with neuraxial anaesthesia (Figure 3).

3.3. Secondary Outcomes

There were no statistically significant differences in the risks of post-operative pulmonary embolism (PE), acute myocardial infarction (AMI) and post-operative stroke. Post-operative PE was assessed by nine studies (n = 3202). The pooled risk ratio was 0.69 (p = 0.40, 95%CI = 0.39 to 1.06) with neuraxial anaesthesia (Figure 4).
Post-operative AMI was assessed by eleven studies (n = 4174). The pooled risk ratio was 0.65 (p = 0.09, 95%CI = 0.39 to 1.06) with neuraxial anaesthesia (Figure 4). A post-operative AMI event was included in the analysis if it was documented in the morbidity or mortality reporting within 28 post-operative days (Supplementary Figure S2).
Post-operative stroke was assessed by eleven studies (n = 3959). The pooled risk ratio of 1.01 (p = 0.97, 95%CI = 0.44 to 2.31) indicated no difference between neuraxial and general anaesthesia (Figure 4). A post-operative stroke event was included if it was documented to occur within 28 post-operative days (Supplementary Figure S2).

3.4. Overall

Figure 5 summarises the findings of primary and secondary dichotomous outcomes. The statistically significant results (p value < 0.05) were a 57.9 mL reduction in blood loss with neuraxial anaesthesia (see Figure 3) and a 45% risk reduction in DVT with neuraxial anaesthesia.

3.5. Year Dependant Confounders

Thirteen studies in the ‘pre-1990’ and eight studies in the ‘2010+’ were assessed in a subgroup analysis of thrombotic complications (Figure 6). These date ranges were chosen due to the clustering of studies in these two time periods (Figure 2). Four studies were published between 1990 and 2010; however, three lacked outcomes on thrombotic complications and the only excluded study in this analysis had a low sample size of 43 patients [19].
There were no statistically significant differences in the year-dependent subgroup analysis. Diagnosis of DVT had a reduction from 28% to 2% in the general anaesthesia group from pre-1990 to post-2010; however, the risk ratio of 0.53 (p = 0.51, 95%CI = 0.10 to 3.14) remained constant post-2010. The incidence of PE in the spinal group remained the same, whereas PE in general anaesthesia patients reduced from 1.2% to 0.5% post-2010. The PE risk ratio of 0.79 (p = 0.69, 95%CI = 0.26 to 2.44) did not change significantly post-2010. Myocardial infarction rates decreased by 38% and 55%, respectively, in the spinal and general anaesthesia subgroups post-2010. The AMI spinal post-2010 risk ratio was 0.74 (p = 0.32, 95%CI = 0.41 to 1.34). The pooled risk ratio for stroke of 1.85 (p = 0.35, 95%CI = 0.51 to 6.68) indicates an 85% increased risk of stroke with spinal anaesthesia pre-1990. Post-2010, the risk ratio reduced to 0.66 (p = 0.45, 95%CI = 0.23 to 1.94) indicating that spinal anaesthesia now has a 34% risk reduction in stroke incidence, albeit this is not statistically significant.

4. Discussion

The results of this systematic review and meta-analysis show that patients who receive general anaesthesia for an acute hip fracture have a statistically significant increased risk of deep vein thrombosis and a clinically insignificant increased risk of bleeding. Despite this, general anaesthesia has been shown to result in a shorter-duration hospital stay, due to neuraxial anaesthesia having a higher rate of UTIs in patients, likely due to the increased duration of bladder catheterisation [41].

5. Primary Outcomes

Intra-operative blood loss was higher in the patients receiving general anaesthesia by an average of 58-millilitres, which is not clinically significant, despite being statistically significant (p = 0.01). There is no absolute consensus on what constitutes clinically significant blood loss in frail patients undergoing surgery for neck of femur fracture, and debate persists regarding the optimal haemoglobin transfusion trigger in this cohort [42,43]. NICE guidelines define a blood loss of 500 mL as “moderate,”, warranting heightened vigilance and the consideration of blood-conservation measures [44]. Similarly, the Association of Anaesthetists recommend a pre-operative haemoglobin threshold > 90 g/L, reflecting the recognition of the high risk of bleeding-related morbidity in the frail population [45,46]. However, in elderly patients with limited cardiorespiratory reserve, even volumes lower than the NICE “moderate” cut-off may precipitate decompensation [47]. A more individualised approach is provided by the following maximum allowable blood loss (MABL) formula: MABL = estimated blood volume × (actual haematocrit–acceptable haematocrit)/actual haematocrit, which incorporates both physiology and reserve, based on the clinician’s determination of the acceptable haematocrit [48]. For this study, a clinically significant blood loss was defined as 800 mL, based on a 60 kg elderly female with an initial haematocrit of 35% and a lowest acceptable haematocrit of 27%. This approach is an ongoing example of the complexity faced by anaesthetists managing these fragile patients having major orthopaedic surgery where even “moderate” blood loss can have disproportionate consequences.
Benson et al. (2000) found a major contributing factor for increased blood loss under general anaesthesia to be an increased duration of surgery [49]. Additionally, core body temperature drops lower when using general anaesthesia, as the ability to self-thermoregulate is lost, compared to neuraxial anaesthesia, where non-affected dermatomes, myotomes and the hypothalamus can adjust [49]. When core temperature drops below 35-degrees, platelet function and fibrinogen synthesis can be impaired, hence causing a temperature-dependent coagulopathy [50].
Of the medications used in the studies, halothane and single high-dose droperidol have been shown to inhibit platelet aggregation and hence potentially increase the bleeding outcomes in the general anaesthetic group of these studies. The studies using halothane and induction-dose droperidol were removed in a subgroup analysis of blood loss, which resulted in the greater blood loss of 80.7 mls (p = 0.007; 95%CI = −139.8 to −21.58 mls; I2 = 86%) in the general anaesthetic group, compared to 57.5 mls when these medications were included. Therefore, these medications were not a confounding factor in the overall pooled analysis.
Intra- or post-operative blood transfusion rate was similar between groups. Given that the risk ratio of 0.93 is approaching 1, this indicates there is no statistical difference between neuraxial and general anaesthesia.
Post-operative deep vein thrombosis risk is classically described by Virchow’s triad of inflammation, venous stasis and hypercoagulability. In our analysis, rates of thrombotic complications declined substantially in studies published after 2010. This trend likely reflects broader advances in peri-operative care, including the routine use of tranexamic acid, anti-embolism stockings, chemical thromboprophylaxis, cemented arthroplasty techniques and fast-track surgical pathways [13,51,52]. The pooled subgroup analysis demonstrated a 15-fold reduction in DVT incidence over time across both the neuraxial and general anaesthesia groups, underscoring the importance of temporal confounders that have dramatically reduced the absolute risk of DVT. While the core principles of orthopaedic post-operative management have remained consistent over time, the increasing implementation of enhanced recovery after surgery (ERAS) protocols, with multi-modal analgesia for early mobilisation, may reduce the relative importance of anaesthetic technique on DVT incidence in the future.
However, few trials quantified time to ambulation, limiting our ability to directly compare mobilisation as a confounder of thrombotic risk. Neuman et al. (2021) provided the most contemporary evidence, finding no difference in DVT incidence between anaesthetic techniques in 1600 patients, with both groups mobilised by post-operative day one [14]. This is consistent with neuraxial anaesthesia, which consistently shows a 50% lower DVT rate compared with general anaesthesia across the eras. Despite neuraxial anaesthesia causing paralysis of the skeletal muscle pump, sympatholysis results in vasodilation and increased blood flow to the lower limbs, which offsets venous stasis and may explain the reduced rate of DVT in both legs [18,21]. Additional evidence found neuraxial anaesthesia was associated with reduced post-operative C-reactive protein levels in knee arthroplasty patients, possibly due to the inhibition of nociceptive afferent pathway activation subsequently reducing antidromic neurogenic inflammation and systemic stress responses [53].
The persistent trend toward lower DVT incidence when using neuraxial anaesthesia raises an important clinical consideration for anaesthetists managing elderly patients. While modern prophylaxis and surgical techniques reduce baseline risk, anaesthetic choice remains one of the few modifiable intra-operative factors influencing venous thromboembolism and must be weighed against patient comorbidities and contraindications to neuraxial techniques.

Secondary Outcomes

Post-operative pulmonary embolism rates have remained relatively consistent across anaesthetic techniques from pre-1990 to post-2010. Apparent similarities in earlier decades are likely influenced by under-detection bias since computed tomography pulmonary angiography (CTPA), the current diagnostic gold standard, only became widely available in the mid-to-late 1980s. Consequently, most trials conducted before this period relied on clinical suspicion or post-mortem findings to establish a diagnosis of PE [54,55].
In current practice, persistently low rates of PE may reflect the marked reduction in deep vein thrombosis (DVT) incidence with improved thromboprophylaxis strategies [56,57]. However, given that DVT is the primary precursor to PE, the inability to fully account for the numerous confounding factors influencing DVT risk reduces confidence in attributing changes in PE incidence directly to anaesthetic technique.
Post-operative myocardial infarction has a 35% relative risk reduction when using neuraxial anaesthesia compared to general anaesthesia. Overall, the incidence of AMI has declined substantially, halving from pre-1990 levels to the rates observed in the post-2010 period. Interestingly, earlier studies demonstrated larger relative risk reductions with neuraxial techniques. This discrepancy may reflect advances in peri-operative care and the improvement of cardiac-stable general anaesthesia delivery [58].
Post-operative stroke events were included if they occurred within 28 post-operative days. This is in keeping with the SNACC consensus definition of peri-operative stroke as occurring within 30 days of surgery [59].
Stroke was twice as likely to occur in the neuraxial group in studies conducted prior to 1990. McKenzie et al. [19] observed that neuraxial anaesthesia was associated with a 20 mmHg greater drop in systolic blood pressure. Two neuraxial patients who developed stroke experienced sustained hypotension exceeding 30% of baseline values, suggesting intra-operative hypotension as a causal factor [19].
In contrast, data from post-2010 studies suggest that the association between neuraxial anaesthesia and stroke has reversed, with a trend toward risk reduction. This shift likely reflects improvements in haemodynamic monitoring and neuraxial agent and dosing, in addition to advances in imaging for accurate diagnosis. Neuraxial anaesthesia is now considered more hemodynamically stable than GA [35,60,61]. This contextualises how historical trial results for stroke complications are no longer applicable to modern clinical practice. Therefore, the post 2010 data showing spinal anaesthesia is protective (rather than having no difference) against stroke, with a 34% relative risk reduction, although not statistically significant, is likely more reflective of current practice, and would require further investigation. Nevertheless, the findings reinforce the limited cerebral autoregulatory reserve of elderly patients and the importance of blood pressure management, regardless of anaesthetic type.

6. Overall

The number of patients included in the analysis is too small to make definitive conclusions; however, the data in analysis supports a trend toward neuraxial anaesthesia being protective for both bleeding and thrombotic complications. The finding that neuraxial anaesthesia reduces bleeding and thrombotic complications means more diligence should be used with general anaesthesia in regard to VTE prevention. High-thrombotic-risk patients should be considered for neuraxial anaesthesia but these patients are often on pre-operative anticoagulation, which may preclude neuraxial procedures. This patient population may result in an anti-thrombotic bias in the general anaesthesia group; however, this was not reflected in our subgroup analysis in regard to deep vein thrombosis, stroke or myocardial infarction. Ensuring TEDs and SCUD application to the non-operative lower leg would decrease DVT risk, as up to a third of DVT cases occur in the non-operative leg [18].

Strengths and Limitations

This meta-analysis is the first to specifically evaluate bleeding and thrombotic complications in patients undergoing hip fracture surgery. A major strength of our study is the inclusion of a large pooled sample size from randomised control trials, including two recent high-quality RCTs (RAGA and REGAIN) [14,15]. Furthermore, our findings are consistent with evidence from trials comparing spinal versus general anaesthesia in total hip arthroplasty patients [62], which supports the external validity of our results.
Several limitations should be acknowledged. Firstly, the included trials varied considerably in sample size, methodological quality and era of conduct. Many older studies utilised anaesthetic techniques and pharmacological agents that are no longer considered standard practice, and advances in peri-operative diagnostics and management, particularly the routine adoption of mechanical and chemical thromboprophylaxis, limit comparability across decades. Smaller studies may also have introduced greater confounding effects, thereby contributing to heterogeneity. However, sensitivity analyses restricted to higher-quality trials did not demonstrate statistically significant differences, which strengthens confidence in the robustness of the findings.
Secondly, the overall low incidence of certain outcomes, coupled with selective outcome reporting in several trials, likely reduced the statistical power of this meta-analysis and contributed to non-significant results. Thirdly, the studies included a large range of patient comorbidities and different fracture and operation types. It is possible that a subgroup of these comorbidities or surgical types may be best managed by a specific anaesthetic type. Unfortunately, the inconsistent reporting of patient-level and procedure-level data across trials prevented subgroup analyses exploring these potential confounders.

7. Conclusions

Patients undergoing acute hip fracture surgery under general anaesthesia have higher volumes of blood loss, without requiring increased blood transfusion. General anaesthesia is also associated with higher thrombotic complications, with a 45% increased relative risk of deep vein thrombosis, compared to neuraxial anaesthesia. Multi-modal thromboprophylaxis is important, as up to a third of DVT cases occur in the non-operative leg. In frail patients with low cardiopulmonary reserve for bleeding or high-thrombotic-risk patients, extra consideration and optimisation for neuraxial technique is advised. Future studies would benefit from investigating whether comorbidities and operation type has an influence on bleeding and thrombotic complications that might be best managed by a specific anaesthetic type.

Supplementary Materials

The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/anesthres2040025/s1, Figure S1: Risk of bias assessment; Figure S2: Secondary outcome diagnostic inclusion—support for judgement; Figure S3: Study characteristics; Figure S4: Justification for risk of bias assessment; Figure S5: Funnel plot representation of publication bias.

Author Contributions

Conceptualisation, A.L.; methodology, L.W. and N.Y.; software, A.L. and N.Y.; data sourcing, G.V.; validation, A.L., N.Y. and M.B.; formal analysis, A.L. and N.Y.; investigation, A.L. and N.Y.; writing—draft preparation, A.L.; writing—review and editing, A.L. and N.Y.; supervision, L.W.; project administration, L.W. and A.L. All authors have read and agreed to the published version of the manuscript.

Funding

The authors have no sources of funding to declare for this manuscript.

Informed Consent Statement

Due to the nature of a meta-analysis, patient consent was not required as individual patient information was not used.

Conflicts of Interest

The authors declare no conflicts of interest.

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Anesthres 02 00025 g001
Figure 1. PRISMA flow diagram of article selection.
Figure 1. PRISMA flow diagram of article selection.
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Figure 2. Study characteristics [14,15,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39]. DVT (deep vein thrombosis), PE (pulmonary embolism), AMI (acute myocardial infarction) and CSE (combined spinal epidural).
Figure 2. Study characteristics [14,15,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39]. DVT (deep vein thrombosis), PE (pulmonary embolism), AMI (acute myocardial infarction) and CSE (combined spinal epidural).
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Figure 3. Forest plot for intra-operative blood loss, blood transfusion and post-operative deep vein thrombosis [14,15,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39].
Figure 3. Forest plot for intra-operative blood loss, blood transfusion and post-operative deep vein thrombosis [14,15,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39].
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Figure 4. Forest plot for post-operative PE, AMI and stroke [14,15,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39].
Figure 4. Forest plot for post-operative PE, AMI and stroke [14,15,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39].
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Figure 5. Meta-analysis summary of findings using Cochrane GRADE approach [40].
Figure 5. Meta-analysis summary of findings using Cochrane GRADE approach [40].
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Figure 6. Comparison of studies pre-1990 vs. post-2010 in regard to outcome. Results represented by number (%).
Figure 6. Comparison of studies pre-1990 vs. post-2010 in regard to outcome. Results represented by number (%).
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Lyons, A.; Yii, N.; White, L.; Bright, M.; Velli, G. The Effect of General Versus Neuraxial Anaesthesia on Bleeding and Thrombotic Outcomes in Neck of Femur Fracture Surgery: A Meta-Analysis. Anesth. Res. 2025, 2, 25. https://doi.org/10.3390/anesthres2040025

AMA Style

Lyons A, Yii N, White L, Bright M, Velli G. The Effect of General Versus Neuraxial Anaesthesia on Bleeding and Thrombotic Outcomes in Neck of Femur Fracture Surgery: A Meta-Analysis. Anesthesia Research. 2025; 2(4):25. https://doi.org/10.3390/anesthres2040025

Chicago/Turabian Style

Lyons, Alexandra, Nathan Yii, Leigh White, Matthew Bright, and Gina Velli. 2025. "The Effect of General Versus Neuraxial Anaesthesia on Bleeding and Thrombotic Outcomes in Neck of Femur Fracture Surgery: A Meta-Analysis" Anesthesia Research 2, no. 4: 25. https://doi.org/10.3390/anesthres2040025

APA Style

Lyons, A., Yii, N., White, L., Bright, M., & Velli, G. (2025). The Effect of General Versus Neuraxial Anaesthesia on Bleeding and Thrombotic Outcomes in Neck of Femur Fracture Surgery: A Meta-Analysis. Anesthesia Research, 2(4), 25. https://doi.org/10.3390/anesthres2040025

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