TOPLINE: 

Among adults who underwent surgery for hip fracture, neuraxial anesthesia was associated with reduced odds of death and major complications in patients aged 87 years or older with intermediate/high frailty; however, those younger than 87 years with intermediate/high frailty faced higher odds of respiratory and cardiac complications, suggesting the benefits of neuraxial anesthesia may vary by age-frailty subgroup.

METHODOLOGY:

• Researchers conducted a retrospective cohort study using the Premier Healthcare Database in the US from 2016 to 2023 to compare outcomes among 623,122 adults who underwent surgery for hip fracture with either neuraxial or general anesthesia.
• Patients were stratified by age (≤ 71, 72-86, and ≥ 87 years) and Hospital Frailty Risk Score (< 5 vs ≥ 5, representing low vs intermediate/high frailty subgroups), creating six total subgroups for comparison.
• The primary outcome was a composite of mortality, respiratory complications (all causes of respiratory failure), cardiac complications (cardiac failure, arrhythmias, and heart block), acute renal failure, and delirium.
• Secondary outcomes were mortality, individual morbidity outcomes, ICU admission, high opioid use, and prolonged length of stay after the procedure.

TAKEAWAY:

• Neuraxial anesthesia was associated with lower odds of the composite outcome in patients aged 87 years or older with intermediate/high frailty (odds ratio [OR], 0.88; adjusted P < .001) and lower odds of overall mortality (OR, 0.83; adjusted P = .003), particularly in this subgroup (OR, 0.77; adjusted P = .011).
• Overall, neuraxial anesthesia was linked to higher odds of respiratory complications (OR, 1.06; adjusted P = .03), primarily in patients aged 71 years or younger with intermediate/high frailty (OR, 1.16; adjusted P = .035), and higher odds of cardiac complications (OR, 1.07; adjusted P = .008), particularly in patients aged 72-86 years with intermediate/high frailty (OR, 1.11; adjusted P = .035).
• Neuraxial anesthesia was associated with lower odds of acute renal failure overall (OR, 0.87; adjusted P < .001), primarily in patients older than 72 years with intermediate/high frailty (OR, 0.86; adjusted P = .002 for those aged 72-86 years and OR, 0.85; adjusted P = .003 for those aged 87 years or older).
• Neuraxial anesthesia was linked to lower odds of high opioid use for the whole cohort and each subgroup separately and lower odds of ICU admission in patients aged 87 years or older with intermediate/high frailty (OR, 0.82; adjusted P < .001) but higher odds in patients aged 71 years or younger with intermediate/high frailty (OR, 1.16; adjusted P = .019).
• Overall, neuraxial anesthesia was linked to increased odds of discharge to home (OR, 1.08; P < .001), noted for patients aged 71 years or younger with low frailty and those aged 72-86 years irrespective of frailty but not for patients aged 87 years or older with intermediate/high frailty, who had lower odds (OR, 0.90; P = .041).

IN PRACTICE:

“We found that neuraxial anesthesia may be associated with better overall outcomes than general anesthesia in surgically managed hip fracture patients, particularly in reducing morbidity, mortality, and high opioid use,” the researchers reported.

The findings “suggest that perhaps frailty, more than age, should guide anesthesia type selection,” they added.

SOURCE:

This study was led by Periklis Giannakis, MD, of the Department of Anesthesiology, Critical Care & Pain Management at the Hospital for Special Surgery in New York City. It was published online on April 27, 2026, in Anesthesia & Analgesia.

LIMITATIONS:

The retrospective design of the study made it hard to determine cause-and-effect relationships. The lack of detailed patient history and clinical information limited further analysis. The researchers lacked information about whether combined neuraxial and general anesthesia was planned or decided during surgery, and such cases were also excluded from the analysis.

DISCLOSURES:

This study received support from the Anesthesiology Departmental Mission Fund, Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery. One author disclosed holding a US patent for a Multicatheter Infusion System and being the owner of SGM Consulting, LLC, and along with two other authors reported partnership in Parvizi Surgical Innovations, LLC.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.