Does Anesthesia Type Affect Cognitive Decline in Seniors?

TOPLINE:

Older adults undergoing hip fracture surgery experience similar incidences of cognitive decline whether they recieve regional or general anesthesia, with no significant difference in depression, anxiety, or health-related quality of life 1 year after surgery.

METHODOLOGY:

• In a substudy of a phase 3 randomized controlled trial, which was conducted across nine hospitals in China, researchers assessed the impact of regional vs general anesthesia on cognitive outcomes, affective status, and quality of life in older patients who underwent surgery for hip fractures.
• Patients with hip fractures aged ≥ 65 years (N = 950) were randomly assigned to receive either regional anesthesia without sedation, using epidural, spinal, or combined spinal-epidural techniques, or general anesthesia.
• Of these, 139 patients who received general anesthesia (median age, 77 years; 74.1% women) and 154 who received regional anesthesia (median age, 78 years; 74% women) were included in the outcome analysis at 12 months.
• Cognitive function was evaluated before surgery and up to 12 months post-randomization using the Mini-Mental State Examination validated for the older Chinese population.
• The primary outcome was the incidence of postoperative cognitive decline.

TAKEAWAY:

• No significant difference was observed in the incidence of cognitive decline 12 months after hip surgery between patients receiving general anesthesia and those receiving regional anesthesia (29.7% vs 25.4%; adjusted odds ratio, 1.3; P = .39).
• The incidences of major and minor cognitive decline at 12 months were similar in the general and regional anesthesia groups.
• No differences were noted in health-related quality of life, affective status, or the incidence of newly developed dementia between the two anesthesia groups at 12 months postsurgery.
• Patients with preoperative mild cognitive impairment had the highest incidence of major and mild cognitive decline at 12 months postsurgery.

IN PRACTICE:

“Our study provides measured evidence of the vulnerability of patients to long-term cognitive decline,” the authors of the study wrote. “Our data support the importance of preoperative routine cognitive screening to identify vulnerable populations in the hope of providing better perioperative care,” they added.

SOURCE:

The study was led by Ting Li, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University in Wenzhou, China. It was published online on January 23, 2025, in Anaesthesia.

LIMITATIONS:

No limitations were discussed for the study.

DISCLOSURES:

This study was funded by the Natural Science Foundation of China, Zhejiang Province Basic Public Welfare Research Project, and the Clinical Research Foundation of the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University and an NIHR Senior Investigator Award, England. No relevant conflicts of interest were disclosed.

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