Outcomes with spinal versus general anesthesia for patients with and without preoperative cognitive impairment: Secondary analysis of a randomized clinical trial.

Humans Delirium / etiology Postoperative Complications Cognitive Dysfunction / complications Anesthesia, General / adverse effects Hip Fractures / complications
anesthesia delirium dementia hip fracture mild cognitive impairment surgery

Journal

Alzheimer's & dementia : the journal of the Alzheimer's Association
ISSN: 1552-5279
Titre abrégé: Alzheimers Dement
Pays: United States
ID NLM: 101231978

Informations de publication

Date de publication:
09 2023
Historique:
revised: 14 02 2023
received: 10 10 2022
accepted: 25 02 2023
medline: 15 9 2023
pubmed: 12 5 2023
entrez: 12 5 2023
Statut: ppublish

Résumé

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. 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. 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. Anesthesia type is not associated with differences in delirium and functional outcomes among persons with or without cognitive impairment.

Identifiants

DOI: 10.1002/alz.13132 PMID: 37170754
pubmed: 37170754
doi: 10.1002/alz.13132
doi:

Types de publication

Randomized Controlled Trial Multicenter Study Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

4008-4019

Informations de copyright

© 2023 the Alzheimer's Association.

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Auteurs

Kyra O'Brien (K)

Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.

Rui Feng (R)

Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.

Frederick Sieber (F)

Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.

Edward R Marcantonio (ER)

Department of Medicine, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts, USA.

Ann Tierney (A)

Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.

Jay Magaziner (J)

Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.

Jeffrey L Carson (JL)

Division of General Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.

Derek Dillane (D)

Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Canada.

Daniel I Sessler (DI)

Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA.

Diane Menio (D)

Center for Advocacy for the Rights and Interests of the Elderly, Philadelphia, Pennsylvania, USA.

Sabry Ayad (S)

Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA.

Trevor Stone (T)

Department of Orthopaedics, University of British Columbia, Vancouver, Canada.

Steven Papp (S)

Division of Orthopaedics, Ottawa Hospital Civic Campus, Ottawa, Canada.

Eric S Schwenk (ES)

Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA.

Mitchell Marshall (M)

Department of Anesthesiology, New York University Langone Medical Center, New York, New York, USA.

J Douglas Jaffe (JD)

Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.

Charles Luke (C)

Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.

Balram Sharma (B)

Department of Anesthesiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA.

Syed Azim (S)

Department of Anesthesiology, Stony Brook University, Stony Brook, New York, USA.

Robert Hymes (R)

Department of Orthopedic Surgery, Inova Fairfax Medical Campus, Falls Church, Virginia, USA.

Ki-Jinn Chin (KJ)

Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada.

Richard Sheppard (R)

Department of Anesthesiology, Hartford Hospital, Hartford, Connecticut, USA.

Barry Perlman (B)

Department of Internal Medicine, Peacehealth Medical Group, Springfield, Oregon, USA.

Joshua Sappenfield (J)

Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA.

Ellen Hauck (E)

Department of Anesthesiology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA.

Mark A Hoeft (MA)

Department of Anesthesiology, University of Vermont Larner College of Medicine, Burlington, Vermont, USA.

Jason Karlawish (J)

Department of Internal Medicine, Division of Geriatric Medicine, Perelman School of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.

Samir Mehta (S)

Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.

Derek J Donegan (DJ)

Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.

Annamarie Horan (A)

Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.

Susan S Ellenberg (SS)

Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.

Mark D Neuman (MD)

Department of Internal Medicine, Division of Geriatric Medicine, Perelman School of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Outcomes with spinal versus general anesthesia...
questionsmedicales.fr › Troubles mentaux › Troubles neurocognitifs › Délire avec confusion › Outcomes with spinal versus general anesthesia...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Complications postopératoires › Outcomes with spinal versus general anesthesia...
questionsmedicales.fr › Troubles mentaux › Troubles neurocognitifs › Troubles de la cognition › Dysfonctionnement cognitif › Outcomes with spinal versus general anesthesia...
questionsmedicales.fr › Anesthésie et analgésie › Anesthésie › Anesthésie générale › Outcomes with spinal versus general anesthesia...
questionsmedicales.fr › Plaies et blessures › Traumatismes de la jambe › Fractures du fémur › Fractures de la hanche › Outcomes with spinal versus general anesthesia...