Outcome Differences Between General and Neuraxial Anesthesia for Hip Fracture by Frailty and Age in the Elderly: A Retrospective Cohort Study
Main finding · Composite of mortality and major system complications, ≥87 years with intermediate/high frailty (subgroup)Result — go to the resultOdds ratio 0.88 95% CI 0.83–0.94Authors' conclusion
Neuraxial versus general anesthesia showed modest overall benefits after hip fracture, varying by age-frailty subgroup
Study context
- Population
- Adults undergoing hip fracture surgery, Premier Healthcare Database 2016–2023, stratified by age (≤71, 72–86, ≥87 years) and Hospital Frailty Risk Score (HFRS) (low, intermediate/high)
- Participants
- 623,122 adults
- Exposure
- Neuraxial vs general anaesthesia
- Outcome
- In-hospital composite of:
- Mortality
- Major system complications
- Follow-up
- In-hospital
Methodological detailsmixed-effects models, age-frailty subgroup analysis
- Mixed-effects models
- Age-frailty subgroup analysis
Main finding
As reported in the abstract
Composite of:
- Mortality and major system complications
- ≥87 years with intermediate/high frailty (subgroup)
Odds ratio
0.88
95% CI 0.83–0.94
P < 0.001
Neuraxial vs General
OR 0.88 (95% CI 0.83–0.94); P < 0.001
Observational data: associations, not effects.
Further findings
| Outcome | OR (95% CI) | P value | |
|---|---|---|---|
| Respiratory complications, overallDriven by patients ≤71 years with intermediate/high frailty | 1.06 (1.01–1.10) | P = 0.03 | |
| Renal failure, overall | 0.87 (0.83–0.92) | P < 0.001 | |
| Cardiac complications, overall | 1.07 (1.02–1.12) | P = 0.008 | |
| Prolonged LOS (≥75th percentile) (subgroups)Neuraxial vs General · 72 to 86 years, low frailty | 1.16 (1.04–1.31) | P = 0.035 | |
| Prolonged LOS (≥75th percentile) (subgroups)Neuraxial vs General · ≥87 years, intermediate/high frailty | 0.92 (0.87–0.97) | P = 0.012 | |
| Discharge homeNeuraxial vs General · overall | 1.08 (1.04–1.12) | P < 0.001 | |
| Discharge homeNeuraxial vs General · ≥87 years, intermediate/high frailty | 0.90 (0.81–0.99) | P = 0.041 | |
| 0.512Odds ratio (log scale) |
- Renal failure, overall: primarily among those ≥72 years with intermediate/high frailty
- Cardiac complications, overall: particularly in patients aged 72 to 86 years with intermediate/high frailty
High opioid use
- Neuraxial associated with lower odds of high opioid use overall and within each subgroup
Safety
| Outcome | OR (95% CI) | P value | |
|---|---|---|---|
| Respiratory complications, overallDriven by ≤71 years with intermediate/high frailty | 1.06 (1.01–1.10) | P = 0.03 | |
| Renal failure, overallPrimarily ≥72 years with intermediate/high frailty | 0.87 (0.83–0.92) | P < 0.001 | |
| Cardiac complications, overallParticularly 72 to 86 years with intermediate/high frailty | 1.07 (1.02–1.12) | P = 0.008 | |
| 0.512Odds ratio (log scale) |
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Outcome Differences Between General and Neuraxial Anesthesia for Hip Fracture by Frailty and Age in the Elderly: A Retrospective Cohort Study. Anesth Analg. Published 27 April 2026. doi:10.
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