China-wide study improves understanding of fatal surgical complications

A China-wide study explores postoperative delirium in older people with hip fractures. Credit: University of Birmingham

Older patients in hospitals across China participated in a major multicenter open-label randomized clinical trial that showed there was no difference in postoperative delirium in older people with hip fracture, if they had general anesthesia or regional anesthesia.

Postoperative delirium is a serious and common neurological complication characterized by a sudden change in people’s brain functions after an operation. It is more common in the elderly and leads to increased deaths, dementia, post-traumatic stress disorder, longer hospital stays, additional nursing needs and increased healthcare costs.

People who have had a hip fracture need to have an operation to repair the fracture that requires anesthesia, classified as general anesthesia or regional anesthesia. A general anesthetic technique is to induce sleep or loss of consciousness by inhaled or intravenous anesthetics. Regional anesthesia involves injecting a local anesthetic inside the spine or around the nerves to prevent pain in the leg with the hip fracture.

It was generally believed that one of the causes of delirium was general anesthesia. Led by the University of Birmingham and the Second Affiliated Hospital of Wenzhou Medical University, this randomized trial was the first of its kind in China. 950 elderly people participated, from hospitals in Wenzhou, Wuhan, Lishui, Ningbo, Nanchang and Taizhou.

The trial was set up to provide clinical evidence with a robust methodology, to help healthcare professionals select an appropriate anesthesia for older patients in an attempt to reduce the development of delirium.

Researchers from Birmingham and WenZhou today published the results in JAMA. Following hip fracture surgery, delirium occurred in 6.2% of the group who received general anesthesia and 5.1% of those who received regional anesthesia. The difference between the two groups could be explained by chance.

The lead investigator of the RAGA trial, Professor Fang Gao, University of Birmingham, NIHR Principal Investigator, commented: “There is a high incidence of delirium after surgery in patients with fracture of the bone. the hip, but we had no strong evidence demonstrating the effectiveness of the two most commonly used anesthetic techniques that induce delirium, creating an urgent need to investigate the prevention of delirium.

“The causes of delirium remain poorly understood, but our trial shows that factors such as general anesthetic agents, which we believed to be associated with delirium, are in fact unlikely to cause delirium.”

“Our trial also provided clinical evidence on the safety of RA and GA in elderly patients for hip fracture surgery, helping anesthesiologists select an appropriate anesthesia for these patients, especially those at high risk of POD. “

The elderly population has grown rapidly over the past 20 years in most parts of the world and the number of elderly people undergoing surgery has increased. Hip fractures are a global health problem, with more than 1.6 million patients suffering from such injuries each year worldwide. Some 680,000 of these injuries occur among the 70 million elderly people in China, and it is predicted that 50 percent of total hip fractures worldwide will occur in Asia by 2050.

Dr Thomas Jackson, Associate Professor of Geriatric Medicine and Board Member of the European Delirium Association, says: “Delirium is first and foremost a de-stressing condition for sufferers and their caregivers. day, we have no treatment that can shorten or stop delirium as it develops.

“This trial is an important step in our understanding of how people develop delirium after surgery. By showing that general anesthesia is not a probable cause of delirium, researchers will be able to further investigate other areas. , such as the body’s inflammatory response to the surgery itself, and how this is reflected in the brain. ”

Broken Myth: General Anesthesia Is As Safe As Spinal Anesthesia After Broken Hip Surgery

More information:
Ting Li et al, Effect of regional anesthesia versus general anesthesia on the incidence of postoperative delirium in older patients undergoing hip fracture surgery, JAMA (2021). DOI: 10.1001 / jama.2021.22647

Provided by the University of Birmingham

Quote: China-Wide Study Improves Understanding of Fatal Surgical Complications (2021, December 21) Retrieved December 21, 2021 from -fatal-surgical-complication.html

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