Effect of Regional vs General Anesthesia on Incidence of Postoperative Delirium in Older Patients Undergoing Hip Fracture Surgery The RAGA Randomized Trial

doi:10.1001/jama.2021.22647

科研成果详情

题名	Effect of Regional vs General Anesthesia on Incidence of Postoperative Delirium in Older Patients Undergoing Hip Fracture Surgery The RAGA Randomized Trial
作者	Li, Ting1,2,3; Li, Jun1,2; Yuan, Liyong 4; Wu, Jinze5; Jiang, Chenchen2,3; Daniels, Jane 6; Mehta, Rajnikant Laxmishanker 7; Wang, Mingcang 8; Yeung, Joyce 9,10; Jackson, Thomas 11; Melody, Teresa 10; Jin, Shengwei1,2; Yao, Yinguang 12,13; Wu, Jimin 14; Chen, Junping 15; Smith, Fang Gao 1,2,10,11; Lian, Qingquan1,2
发表期刊	JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION 影响因子和分区
语种	英语
原始文献类型	Article
其他关键词	ELDERLY-PATIENTS ; CONSENSUS ; OUTCOMES ; MODE
摘要	IMPORTANCE In adults undergoing hip fracture surgery, regional anesthesia may reduce postoperative delirium, but there is uncertainty about its effectiveness. OBJECTIVE To investigate, in older adults undergoing surgical repair for hip fracture, the effects of regional anesthesia on the incidence of postoperative delirium compared with general anesthesia. DESIGN, SETTING, AND PARTICIPANTS A randomized, allocation-concealed, open-label, multicenter clinical trial of 950 patients, aged 65 years and older, with or without preexisting dementia, and a fragility hip fracture requiring surgical repair from 9 university teaching hospitals in Southeastern China. Participants were enrolled between October 2014 and September 2018; 30-day follow-up ended November 2018. INTERVENTIONS Patients were randomized to receive either regional anesthesia (spinal, epidural, or both techniques combined with no sedation; n = 476) or general anesthesia (intravenous, inhalational, or combined anesthetic agents; n = 474). MAIN OUTCOMES AND MEASURES Primary outcome was incidence of delirium during the first 7 postoperative days. Secondary outcomes analyzed in this article include delirium severity, duration, and subtype; postoperative pain score; length of hospitalization; 30-day all-cause mortality; and complications. RESULTS Among 950 randomized patients (mean age, 76.5 years; 247 [26.8%] male). 941 were evaluable for the primary outcome (6 canceled surgery and 3 withdrew consent). Postoperative delirium occurred in 29 (6.2%) in the regional anesthesia group vs 24 (5.1%) in the general anesthesia group (unadjusted risk difference [RD], 1.1%; 95% Cl. -1.7% to 3.8%; P = .48; unadjusted relative risk [RR], 1.2 [95% CI, 0.7 to 2.0]; P = .57]). Mean severity score of delirium was 23.0 vs 24.1, respectively (unadjusted difference. -1.1; 95% Cl. -4.6 to 3.1). A single delirium episode occurred in 16 (3.4%) vs 10 (2.1%) (unadjusted RD, 1.1%; 95% CI, -1.7% to 3.9%; RR, 1.6 [95% CI, 0.7 to 3.5]). Hypoactive subtype in 11(37.9%) vs 5 (20.8%) (RD, 11.5; 95% CI, -11.0% to 35.7%; RR, 2.2 [95% CI, 0.8 to 6.3]). Median worst pain score was 0 (IQR, 0 to 20) vs 0 (IQR, 0 to 10) (difference 0; 95% CI, 0 to 0). Median length of hospitalization was 7 days (IQR, 5 to 10) vs 7 days (IQR, 6 to 10) (difference 0; 95% CI, 0 to 0). Death occurred in 8 (1.7%) vs 4 (0.9%) (unadjusted RD, -0.8%; 95% Cl, -2.2% to 0.7%; RR, 2.0 [95% CI, 0.6 to 6.5]). Adverse events were reported in 106 episodes in the regional anesthesia group and 102 in the general anesthesia group; the most frequently reported adverse events were nausea and vomiting (47 [44.3%] vs 34 [33.3%]) and postoperative hypotension (13 [12.3%] vs 10 [9.8%]). CONCLUSIONS AND RELEVANCE In patients aged 65 years and older undergoing hip fracture surgery, regional anesthesia without sedation did not significantly reduce the incidence of postoperative delirium compared with general anesthesia.
资助项目	Recruitment Program of Global Experts, China; Zhejiang Province Basic PublicWelfare Research Project [LGF21H250004]; Zhejiang Health and Family Planning Commission Programme [2014PYA015]; NIHR Senior Investigator Award; Health Commission of Zhejiang Province; Zhejiang Provincial Department of Science and Technology; Second Affiliated Hospital of Wenzhou Medical University; Yuying Children's Hospital of Wenzhou Medical University
出版者	AMER MEDICAL ASSOC
出版地	CHICAGO
ISSN	0098-7484
EISSN	1538-3598
卷号	327 期号:1 页码:50-58
DOI	10.1001/jama.2021.22647
WOS类目	Medicine, General & Internal
WOS研究方向	General & Internal Medicine
WOS记录号	WOS:000734928000004
收录类别	SCIE ; PUBMED ; SCOPUS
发表日期	2022-01-04
URL	查看原文
Pubmed记录号	34928310
PMC记录号	10.1001/jama.2021.22647
Scopus记录号	2-s2.0-85121567918
ESI高被引论文	2023-01 ; 2023-03 ; 2023-05 ; 2023-07 ; 2023-09 ; 2023-11 ; 2024-01 ; 2024-03 ; 2024-05
自科自定义期刊分类	T1类
引用统计	被引频次：37[WOS] [WOS记录] [WOS相关记录]
文献类型	期刊论文
条目标识符	https://kms.wmu.edu.cn/handle/3ETUA0LF/20439
专题	第二临床医学院、附属第二医院、育英儿童医院附属第一医院其他_附属第五医院（丽水市中心医院）
通讯作者	Smith, Fang Gao; Lian, Qingquan
作者单位	1.Wenzhou Med Univ, Dept Anesthesiol & Perioperat Med, Affiliated Hosp 2, 1111 Wenzhou Ave, Wenzhou 325038, Zhejiang, Peoples R China; 2.Wenzhou Med Univ, Yuying Childrens Hosp, 1111 Wenzhou Ave, Wenzhou 325038, Zhejiang, Peoples R China; 3.Wenzhou Med Univ, Clin Res Unit, Affiliated Hosp 2, Wenzhou, Zhejiang, Peoples R China; 4.Ningbo 6 Hosp, Dept Anesthesiol & Perioperat Med, Ningbo, Zhejiang, Peoples R China; 5.Wenzhou Med Univ, Prov Wenzhou Hosp Zhejiang 1, Dept Anesthesiol & Perioperat Med, Affiliated Hosp 1, Wenzhou, Zhejiang, Peoples R China; 6.Univ Nottingham, Nottingham Clin Trials Unit, Nottingham, England; 7.Univ Birmingham, Birmingham Clin Trials Unit, Birmingham, W Midlands, England; 8.Taizhou Hosp Zhejiang Prov, Dept Anesthesiol & Perioperat Med, Taizhou, Zhejiang, Peoples R China; 9.Univ Warwick, Warwick Clin Trials Unit, Warwick, England; 10.Univ Hosp Birmingham NHS Fdn Trust, Birmingham, W Midlands, England; 11.Univ Birmingham, Inst Inflammat & Ageing, Birmingham, W Midlands, England; 12.Lishui Cent Hosp, Lishui Municipal Peoples Hosp, Dept Anesthesia & Crit Care, Lishui, Zhejiang, Peoples R China; 13.Wenzhou Med Coll, Affiliated Hosp 5, Lishui, Zhejiang, Peoples R China; 14.Lishui City Peoples Hosp, Dept Anesthesia & Crit Care, Lishui, Zhejiang, Peoples R China; 15.Univ Chinese Acad Sci, Hwa Mei Hosp, Dept Anesthesia & Crit Care, Ningbo 2 Hosp, Ningbo, Zhejiang, Peoples R China
第一作者单位	第二临床医学院，附属第二医院、育英儿童医院; 附属第二医院
通讯作者单位	第二临床医学院，附属第二医院、育英儿童医院; 附属第二医院
第一作者的第一单位	第二临床医学院，附属第二医院、育英儿童医院
推荐引用方式 GB/T 7714	Li, Ting,Li, Jun,Yuan, Liyong,et al. Effect of Regional vs General Anesthesia on Incidence of Postoperative Delirium in Older Patients Undergoing Hip Fracture Surgery The RAGA Randomized Trial[J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION,2022,327(1):50-58.
APA	Li, Ting., Li, Jun., Yuan, Liyong., Wu, Jinze., Jiang, Chenchen., ... & Lian, Qingquan. (2022). Effect of Regional vs General Anesthesia on Incidence of Postoperative Delirium in Older Patients Undergoing Hip Fracture Surgery The RAGA Randomized Trial. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 327(1), 50-58.
MLA	Li, Ting,et al."Effect of Regional vs General Anesthesia on Incidence of Postoperative Delirium in Older Patients Undergoing Hip Fracture Surgery The RAGA Randomized Trial".JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION 327.1(2022):50-58.