Effect of Regional vs General Anesthesia on Incidence of Postoperative Delirium in Older Patients Undergoing Hip Fracture Surgery: The RAGA Randomized Trial
Hypothesis: Regional anesthesia will result in a decreased incidence and severity of postoperative delirium as compared to general anesthesia
Methods
Prospective
9 locations in China
Participants
aged 65 or older
hip fracture
ASA I-IV
Primary outcome: Incidence of delirium within 7 days after surgery, using the CAM scale
Results: No difference in the incidence of delirium between the regional (6.2%) and GA (5.1%) groups (between group difference 1.1%, 95% CI -1.7% - 3.8%, P = .48)
Strengths
No sedation in the regional anesthesia group
Well-validated assessment tools for post-op delirium
Large # of subjects
Multicenter
Broad inclusion criteria
Weaknesses
Generalizability
All sites in China
Most patients from 1 center
Study population relatively healthy
Patients with preop delirium not excluded
Postop delirium rates lower than expected
Long-term outcomes not evaluated
Not enough data on specifics of anesthetic care
Postop analgesia/care not protocolized
Underpowered
Key Point: The use of regional anesthesia for patients with hip fractures does not reduce the incidence of delirium compared to GA