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Research article
Zhiheng Liu
Corresponding Author
ORCiD: https://orcid.org/0000-0002-2823-543X
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Background: The choice of anesthesia technique remains debatable in patients undergoing surgical repair of hip fracture. This meta-analysis was performed to compare the effect of neuraxial (epidural/spinal) versus general anesthesia on perioperative outcomes in patients undergoing hip fracture surgery.
Methods: Medline, Cochrane Library, Science-Direct, and EMBASE databases were searched to identify eligible studies focused on the comparison between neuraxial and general anesthesia in hip fracture patients between January 2000 and May 2019. Perioperative outcomes were extracted for systemic analysis. The sensitivity analyses were conducted using a Bonferroni correction and the leave-one-out method. The evidence quality for each outcome was evaluated by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.
Results: Nine randomized controlled trials (RCTs) including 1084 patients fulfilled our selection criteria. The outcomes for the meta-analysis showed that there were no significant differences in the 30-day mortality (OR = 1.34, 95% CI 0.56, 3.21; P = 0.51), length of stay (MD = -0.65, 95% CI -0.32, 0.02; P =0.06), and the prevalence of delirium (OR = 1.05, 95% CI 0.27, 4.00; P = 0.95), acute myocardial infarction (OR = 0.88, 95% CI 0.17, 4.65; P = 0.88), deep venous thrombosis (OR = 0.48, 95% CI 0.09, 2.72; P = 0.41), and pneumonia (OR = 1.04, 95% CI 0.23, 4.61; P = 0.96) for neuraxial anesthesia compared to general anesthesia, and there was a significant difference in blood loss between the two groups (MD = -137.8, 95% CI -241.49, -34.12; p = 0.009). However, after applying the Bonferroni correction for multiple testing, all the adjusted p-values were above the significant threshold of 0.05. The evidence quality for each outcome evaluated by the GRADE system was low.
Conclusions: In summary, our present study demonstrated that there might be a difference in blood loss between patients receiving neuraxial and general anaesthesia, however, this analysis was not robust to adjustment for multiple testing and therefore at high risk for a type I error. Due to small sample size and enormous inconsistency in the choice of outcome measures, more high-quality studies with large sample size are needed to clarify this issue.
Keywords
Neuraxial anesthesia, General anesthesia, Hip fracture.
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CURRENT STATUS: Published
View the published article at BMC Anesthesiology.
Version 4
Posted 28 May, 2020
No community comments so far
Editorial decision: Minor revision
On 11 Jun, 2020
Review #1 received
Received 03 Jun, 2020
Reviewer #1 agreed
On 21 May, 2020
Reviewers invited
Invitations sent on 19 May, 2020
Editor assigned
On 18 May, 2020
Submission checks complete
On 17 May, 2020
Editor invited
On 17 May, 2020
No comments provided
Editorial decision: Minor revision
On 13 May, 2020
Review #1 received
Received 11 May, 2020
Reviewer #1 agreed
On 22 Apr, 2020
Reviewers invited
Invitations sent on 21 Apr, 2020
Editor assigned
On 20 Apr, 2020
Submission checks complete
On 19 Apr, 2020
Editor invited
On 19 Apr, 2020
No comments provided
Editorial decision: Major revision
On 27 Mar, 2020
Review #1 received
Received 22 Feb, 2020
Reviewers invited
Invitations sent on 07 Feb, 2020
Reviewer #1 agreed
On 07 Feb, 2020
Editor assigned
On 03 Feb, 2020
Submission checks complete
On 02 Feb, 2020
Editor invited
On 02 Feb, 2020
No comments provided
Editorial decision: Major revision
On 10 Jan, 2020
Review #2 received
Received 02 Jan, 2020
Review #1 received
Received 27 Dec, 2019
Reviewer #2 agreed
On 19 Dec, 2019
Reviewers invited
Invitations sent on 02 Dec, 2019
Reviewer #1 agreed
On 02 Dec, 2019
Editor assigned
On 07 Nov, 2019
Submission checks complete
On 06 Nov, 2019
Editor invited
On 06 Nov, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Anesthesiology & Pain Medicine
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A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
See the published version of this preprint at BMC Anesthesiology.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Zhiheng Liu
Corresponding Author
ORCiD: https://orcid.org/0000-0002-2823-543X
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Anesthesiology.
Version 4
Posted 28 May, 2020
No community comments so far
Editorial decision: Minor revision
On 11 Jun, 2020
Review #1 received
Received 03 Jun, 2020
Reviewer #1 agreed
On 21 May, 2020
Reviewers invited
Invitations sent on 19 May, 2020
Editor assigned
On 18 May, 2020
Submission checks complete
On 17 May, 2020
Editor invited
On 17 May, 2020
No comments provided
Editorial decision: Minor revision
On 13 May, 2020
Review #1 received
Received 11 May, 2020
Reviewer #1 agreed
On 22 Apr, 2020
Reviewers invited
Invitations sent on 21 Apr, 2020
Editor assigned
On 20 Apr, 2020
Submission checks complete
On 19 Apr, 2020
Editor invited
On 19 Apr, 2020
No comments provided
Editorial decision: Major revision
On 27 Mar, 2020
Review #1 received
Received 22 Feb, 2020
Reviewers invited
Invitations sent on 07 Feb, 2020
Reviewer #1 agreed
On 07 Feb, 2020
Editor assigned
On 03 Feb, 2020
Submission checks complete
On 02 Feb, 2020
Editor invited
On 02 Feb, 2020
No comments provided
Editorial decision: Major revision
On 10 Jan, 2020
Review #2 received
Received 02 Jan, 2020
Review #1 received
Received 27 Dec, 2019
Reviewer #2 agreed
On 19 Dec, 2019
Reviewers invited
Invitations sent on 02 Dec, 2019
Reviewer #1 agreed
On 02 Dec, 2019
Editor assigned
On 07 Nov, 2019
Submission checks complete
On 06 Nov, 2019
Editor invited
On 06 Nov, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Anesthesiology & Pain Medicine
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Anesthesiology.
Background: The choice of anesthesia technique remains debatable in patients undergoing surgical repair of hip fracture. This meta-analysis was performed to compare the effect of neuraxial (epidural/spinal) versus general anesthesia on perioperative outcomes in patients undergoing hip fracture surgery.
Methods: Medline, Cochrane Library, Science-Direct, and EMBASE databases were searched to identify eligible studies focused on the comparison between neuraxial and general anesthesia in hip fracture patients between January 2000 and May 2019. Perioperative outcomes were extracted for systemic analysis. The sensitivity analyses were conducted using a Bonferroni correction and the leave-one-out method. The evidence quality for each outcome was evaluated by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.
Results: Nine randomized controlled trials (RCTs) including 1084 patients fulfilled our selection criteria. The outcomes for the meta-analysis showed that there were no significant differences in the 30-day mortality (OR = 1.34, 95% CI 0.56, 3.21; P = 0.51), length of stay (MD = -0.65, 95% CI -0.32, 0.02; P =0.06), and the prevalence of delirium (OR = 1.05, 95% CI 0.27, 4.00; P = 0.95), acute myocardial infarction (OR = 0.88, 95% CI 0.17, 4.65; P = 0.88), deep venous thrombosis (OR = 0.48, 95% CI 0.09, 2.72; P = 0.41), and pneumonia (OR = 1.04, 95% CI 0.23, 4.61; P = 0.96) for neuraxial anesthesia compared to general anesthesia, and there was a significant difference in blood loss between the two groups (MD = -137.8, 95% CI -241.49, -34.12; p = 0.009). However, after applying the Bonferroni correction for multiple testing, all the adjusted p-values were above the significant threshold of 0.05. The evidence quality for each outcome evaluated by the GRADE system was low.
Conclusions: In summary, our present study demonstrated that there might be a difference in blood loss between patients receiving neuraxial and general anaesthesia, however, this analysis was not robust to adjustment for multiple testing and therefore at high risk for a type I error. Due to small sample size and enormous inconsistency in the choice of outcome measures, more high-quality studies with large sample size are needed to clarify this issue.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
Figure 7
Figure 8
Figure 9
Figure 10
This is a list of supplementary files associated with this preprint. Click to download.
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