Does choice of anaesthesia perioperatively, affect patient outcome post- neck of femur fracture (NOF) surgery?

Introduction: There is limited evidence regarding the optimal anaesthetic choice for neck of femur (NOF) surgery, particularly in comparing general anaesthesia (GA) versus regional anaesthesia (spinal). While some cohort studies suggest that regional anaesthesia may offer superior post-operative outcomes, including reduced delirium and shorter recovery times, the lack of clear guidelines leaves uncertainty about the best anaesthetic approach for improved patient outcomes.

Methods: This audit aimed to assess the impact of GA versus spinal anaesthesia on patient outcomes in NOF surgery. A cohort of 180 patients with a NOF, was drawn from 238 entries into the National Hip Fracture Database in 2024 at St George's Hospital, London. We compared outcomes between GA and spinal, focusing on post-operative delirium, length of stay (LOS), discharge destination and mortality.

Results: Of the 180 patients, 78.89% received GA and 21.11% received spinal. The results indicated that GA patients had a higher incidence of post-operative delirium (35.91% vs Spinal: 13.16%) and slightly longer LOS (18.92 days vs Spinal: 17.55 days). Discharge destinations were primarily home or bed-based rehabilitation, with GA patients being discharged home in 45.1% of cases and spinal patients 57.1%. Mortality rates were small (GA: 3.52% vs. Spinal: 5.26%); the difference observed between the groups was not statistical difference, possibly due to the few deaths recorded. Also, there was no statistical significance found between the anaesthetic choice compared to ASA grading (p-value=0.68) or pre-mobility status (p-value= 0.54).

Conclusion: The findings suggest that receiving spinal anaesthesia is associated with lower rates of delirium and shorter LOS, with a higher proportion of patients having been discharged home. Further investigation with a larger cohort is necessary to assess the impact of anaesthesia type on patient outcomes. We appreciate that patient factors can also influence anaesthesia choice, and individual patient considerations were not captured in this study.