Clinical effectiveness and safety of spinal anaesthesia compared with general anaesthesia in patients undergoing hip fracture surgery using a consensus-based core outcome set and patient and public informed outcomes : a systematic review and meta-analysis of contemporary randomised controlled trials

Background: We conducted a systematic review and meta-analysis of contemporary RCTs to determine the clinical effectiveness of spinal versus general anaesthesia (SA vs GA) in patients undergoing hip fracture surgery using the consensus-based core outcome set, and outcomes defined as important by patient and public involvement (PPI) initiatives. Methods: RCTs comparing any of the core outcomes (mortality, time from injury to surgery, acute coronary syndrome, hypotension, acute kidney injury, delirium, pneumonia, orthogeriatric input, being out of bed at day-one post-operatively, and pain) or PPI defined outcomes (return to pre-operative residence, quality of life, and mobility status) between SA and GA were identified from MEDLINE, Embase, Cochrane Library, Web of Science (2000 to February 2022). Pooled relative risks (RRs) and mean differences (95% CIs) were estimated. Results: There was no significant difference in the risk of delirium comparing SA versus GA: RR=1.07,CI=0.90-1.29. Comparing SA versus GA, the RR for mortality was 0.56 (CI=0.22-1.44) in-hospital, 1.07(CI=0.52-2.23) at 30-days, and 1.08(CI=0.55-2.12) at 90-days. Spinal anaesthesia reduced the risk of acute kidney injury compared with GA: RR=0.59(CI=0.39-0.89). There were no significant differences in the risk of other outcomes. Few studies reported PPI outcomes, with most studies reporting on 1-3 core outcomes. Conclusion: Except for acute kidney injury, there were no differences between SA and GA in hip fracture surgery when using a consensus-based core outcome set and PPI important outcomes. Most studies reported limited outcomes from the core outcome set and few reported outcomes important to patients, which should be considered when designing future RCTs