Closeup of man on crutches being helped to walk by a physical therapist

Spinal anesthesia is neither more safe nor more effective than general anesthesia for patients undergoing hip fracture surgery, a large new study finds.

Investigators monitored surgical outcomes in 1,600 patients aged 50 years and older across 46 American and Canadian hospitals. Patients were assigned to receive one or the other type of anesthesia. There was no significant difference in the ability to walk 3 meters independently two months after the surgery or in inpatient mortality between the cohorts, the researchers found.

Each group also had similar levels of postoperative delirium — a potentially debilitating problem in many older patients — and lengths of hospital stay. Patients who had spinal anesthesia had slightly smaller risks of death during hospitalization, and of pneumonia or admission to an intensive care unit, reported Derek Dillane, M.D., of the University of Alberta’s Faculty of Medicine & Dentistry.

Assumptions that spinal anesthesia is the safer option are based on smaller, older studies, and the new study results may help patients and their caregivers make more informed presurgical decisions, he and his colleagues said. 

There remain risks and benefits to both types of anesthesia, they added. Recipients of the spinal option who take blood thinners may be at risk of spinal bleeding and a hip fracture patient may find it difficult to lay on their side for the injection procedure in their spine, for example. And studies have suggested that general anesthesia may worsen dementia, they noted.

The ability to walk again is of highest importance to most hip fracture patients, but the anesthesia method used must be tailored towards the individual and take their medical status into account, the authors concluded.

Full findings were published in the New England Journal of Medicine.