Incidence of 12-month postoperative cognitive decline following regional vs. general anaesthesia in older patients undergoing hip fracture surgery: follow-up of the RAGA trial

被引：1

作者：

Li, Ting ^{[1
,2
,3
]}

Li, Jun ^{[1
,2
]}

Jiang, Chenchen ^{[2
,3
]}

Yuan, Liyong ^{[4
]}

Wu, Jinze ^{[5
]}

Mazaheri, Ali ^{[6
,7
]}

Wang, Mingcang ^{[8
]}

Jin, Shengwei ^{[1
,2
]}

Myles, Paul S. ^{[9
,10
]}

Yao, Yinguang ^{[11
]}

Wu, Jimin ^{[12
]}

Chen, Junping ^{[13
]}

Smith, Fang G. ^{[2
,3
,14
]}

RAGA Study Investigators

机构：

[1] Wenzhou Med Univ, Affiliated Hosp & Yuying Childrens Hosp 2, Dept Anesthesiol & Perioperat Med, Wenzhou, Peoples R China

[2] Wenzhou Med Univ, Yuying Childrens Hosp, Wenzhou, Peoples R China

[3] Wenzhou Med Univ, Affiliated Hosp 2, Clin Res Unit, Wenzhou, Peoples R China

[4] Ningbo 6 Hosp, Dept Ultrason Med, Ningbo, Peoples R China

[5] Wenzhou Med Univ, Affiliated Hosp 1, Dept Anaesthesiol & Perioperat Med, Wenzhou, Peoples R China

[6] Univ Birmingham, Sch Psychol, Birmingham, England

[7] Univ Birmingham, Ctr Human Brain Hlth, Birmingham, England

[8] Taizhou Hosp Zhejiang Prov, Dept Vasc Surg, Taizhou, Peoples R China

[9] Alfred Hosp, Dept Anaesthesiol & Perioperat Med, Melbourne, Australia

[10] Monash Univ, Melbourne, Australia

[11] Lishui Municipal Cent Hosp, Dept Anaesthesiol & Perioperat Med, Lishui, Peoples R China

[12] Lishui Peoples Hosp, Dept Anaesthesiol & Perioperat Med, Lishui, Peoples R China

[13] Univ Chinese Acad Sci, Ningbo 2 Hosp, Ningbo Hosp 2, Dept Radiol, Ningbo, Peoples R China

[14] Univ Birmingham, Coll Med & Hlth, Sch Inflammat Infect & Immun, Birmingham, England

来源：

ANAESTHESIA | 2025年

关键词：

general anaesthesia; hip fracture; neurocognitive function; regional anaesthesia; older patients; MENTAL-STATE-EXAMINATION; DYSFUNCTION; IMPAIRMENT; CHINESE;

D O I：

10.1111/anae.16545

中图分类号：

R614 [麻醉学];

学科分类号：

100217 ;

摘要：

IntroductionData regarding the incidence of 12-month postoperative cognitive decline following regional or general anaesthesia in older patients undergoing hip fracture surgery remain observational. Compared with general anaesthesia, we hypothesised that regional anaesthesia would decrease the incidence of 12-month postoperative cognitive decline.MethodsThis is substudy of a multicentre randomised trial of regional anaesthesia with no sedation vs. general anaesthesia with 12-month follow-up, conducted in nine university hospitals in south-eastern China. Patients aged >= 65 y with hip fractures requiring surgery were eligible for inclusion. The prespecified 1-year primary outcome was the incidence of postoperative cognitive decline at 12 months post-randomisation. Secondary outcomes included major or mild postoperative cognitive decline; changes in Mini-Mental State Examination; newly developed dementia; affective status; and health-related quality of life.ResultsWe recruited 950 patients between October 2014 and September 2018 (n = 474 general and n = 476 regional), with the last participant interviewed in November 2019. A total of 293 patients (139 general vs. 154 regional) were included in the primary analysis of the 12-month outcome. Median (IQR [range]) age of patients was 78 (71-82 [65-96]) y and 217 (74.1%) were female. The incidence of cognitive decline at 12 months was 29.7% vs. 25.4% of patients allocated to general vs. regional anaesthesia, respectively (unadjusted OR 1.2 (95%CI 0.7-2.1), p = 0.43, Bayes factor = 0.28). Major cognitive decline developed in 8.6% vs. 8.5% of patients allocated to general vs. regional anaesthesia, respectively (unadjusted OR 1.0 (95%CI 0.4-2.4)).DiscussionThe incidence of 12-month postoperative cognitive decline was not significantly different in patients having general or regional anaesthesia for hip fracture surgery.

引用

页数：10

共 46 条

[1] Effect of Regional vs General Anesthesia on Incidence of Postoperative Delirium in Older Patients Undergoing Hip Fracture Surgery The RAGA Randomized Trial
Li, Ting
Li, Jun
Yuan, Liyong
Wu, Jinze
Jiang, Chenchen
Daniels, Jane
Mehta, Rajnikant Laxmishanker
Wang, Mingcang
Yeung, Joyce
Jackson, Thomas
Melody, Teresa
Jin, Shengwei
Yao, Yinguang
Wu, Jimin
Chen, Junping
Smith, Fang Gao
Lian, Qingquan
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2022, 327 (01): : 50 - 58
[2] Regional vs General Anesthesia and Incidence of Postoperative Delirium in Older Patients Undergoing Hip Fracture Surgery
Nobuhara, Chloe
Devinney, Michael, Jr.
Berger, Miles
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2022, 327 (17): : 1707 - +
[3] Effect of Regional vs General Anesthesia on Incidence of Postoperative Delirium in Older Patients Undergoing Hip Fracture Surgery: The RAGA Randomized Trial (vol 327, pg 50, 2022)
Li, T.
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Yuan, L.
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2022, 327 (12): : 1188 - 1188
[4] Comparison of regional with general anaesthesia on postoperative delirium (RAGA-delirium) in the older patients undergoing hip fracture surgery: study protocol for a multicentre randomised controlled trial
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BMJ OPEN, 2017, 7 (10):
[5] In older adults having hip fracture surgery, regional vs. general anesthesia did not reduce postoperative delirium
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ANNALS OF INTERNAL MEDICINE, 2022, 175 (05) : JC53 - JC53
[6] Effect of regional versus general anaesthesia on postoperative delirium in elderly patients undergoing surgery for hip fracture: a systematic review
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BMJ OPEN, 2018, 8 (12):
[7] Postoperative delirium increases follow-up mortality following hip arthroplasty in older patients with femoral neck fracture
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AUSTRALASIAN JOURNAL ON AGEING, 2024,
[8] Predictors of improvement in quality of life at 12-month follow-up in patients undergoing anterior endoscopic skull base surgery
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[9] The influence of anesthetic techniques on postoperative cognitive function in elderly patients undergoing hip fracture surgery: General vs spinal anesthesia
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INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED, 2018, 49 (12): : 2221 - 2226
[10] Postoperative delirium increases follow-up mortality following hip arthroplasty in older patients with femoral neck fracture Response
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